Tetanus vaccine: case

I haven't posted a case in while so I thought I would put my discussion of shared-decision-making and decision aids on hold, and spend the next couple of posts writing up cases instead.

Scenario

A man sends me an email. He would like some information about tetanus shots. He is scheduled for one the following week and would like to know what to expect in terms of normal reactions because a friend of his told him her arm swelled up a week after getting her shot.

Resolution

Judging from the man's email he has relatively high literacy and so I an able to give him information at a fairly complex level.

MedlinePlus - Medical encyclopedia entry on tetanus vaccines.

Immunization Action Coalition - vaccine information for the public and health professionals: Questions & answers about the tetanus vaccine.

The Immunization Action Coalition works to increase immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public that enhance the delivery of safe and effective immunization services. The Coalition also facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies.

UpToDate - Adult immunization (there is a nice section that covers possible side-effects from mild to severe, and a brief description of tetanus the disease).

Discussion

Immunization is THE top subject of interest to patients at the Herzl. Aside from a few questions I've received on the topic, my website statistics show that so far 832 people have visited the Vaccinations page 501 times since April (when the page was created). In second place is the page providing links to online Resources in French with 627 visits by 224 people (since January); and Heart disease and stroke in third place with 402 visits by 202 people (since March).

Pushing boundaries or juggling hats: challenge

Although my two positions at the hospital are intricately connected, I am paid for them separately, so I try to keep my work in each location as separate as possible in order to honour my obligations to both.

When I got the request for information at the library on pediatric MS from a Herzl resident, it had not yet been established what to do when a Herzl request comes to me when I am at the library. I had another request at the library from Herzl that same week so it seemed imperative that a decision be made regarding procedure.

It has since been decided that I will treat the request as a PFRC request, and also fill out a consult at the Herzl which can then be placed in the chart, which is what I had instinctively thought to do. This seems like a reasonable solution, although it does mean that I may be occasionally counting a single encounter twice.

The head librarian is also available to consult with patients and has said she is happy to help with Herzl requests coming to the library should I not be able to. This is where having the additional support of a library and especially of an existing patient resource centre makes having an in-house service slightly more feasible, especially when the librarian is only on site part-time.