Massachusetts Department of Public Health Training Module

1
Massachusetts Department of Public
HealthTraining Module

• ALL-STAFF BRIEFING
• JUST-IN-TIME TRAINING
• For a Clinic, EDS or POD
• Presented by
• Barbara Coughlin, RN
• Health Educator
• Massachusetts Department of Public Health
• November 15, 2010

2
Objectives

• Identify leadership and direct supervisor(s)
• Identify need for clinic/EDS/POD
• Identify vaccine or medication to be distributed
• Understand the operations plan
• Describe facility and site layout
• Describe safety, security emergency plan
• Understand job assignment(s)
• Identify station assignment(s)

3
All-Staff Briefing

• Purpose To inform and orient all staff working
  at a clinic/EDS/POD on the operations plan

4
Sign-In / Sign-Out

• Sign-in on arrival
• Record arrival time, name, address and other info
  as requested
• Receive job assignment station
• Receive supervisors name
• Verify identification/credentials
• Receive name tag, required attire
• Sign-out on departure
• Record departure time
• Return equipment and unused supplies
• Secure sharps and biologics (if applicable)

5
Leadership and Supervisors(Chain of Command)

• Identify lead organization
• Identify lead staff
• Incident Commander
• EDS Director (if applicable)
• Medical Director
• Clinical Supervisor (patient care)
• Clerical, Safety Security Supervisor(s)
  (patient flow)
• Know direct supervisor
• Make staff introductions

6
Incident Command System (ICS)

• Abbreviated version of ICS
• Flexibility
• Scalability
• Span of control
• Establishes chain of command
• All you need to know
• direct supervisor

7
Reason For Clinic/EDS/POD

• The infectious disease or agent
• The mode of transmission
• (PPE and precautions recommended)
• The treatment or prophylaxis

8
Overview of Operations Plan

• Client flow from arrival to departure
• Target population
• Hours of operation
• Capacity
• Crowd control plan
• Vaccine/medication(s) to be administered or
  dispensed
• Workforce Protection Plan

9
Overview (cont.)

• Required forms, documentation and information
• Reporting problems and concerns
• How to access assistance
• Accommodations for individuals requiring
  additional assistance
• Interpreters and Translated materials (forms and
  screening)
• Staff breaks and shifts
• Clinic/EDS/POD breakdown, clean up

10
Facility/Site Orientation

• Emergency exits
• Restrooms
• Break area
• Secure storage area for clinic supplies
  personal belongings
• Parking for staff
• Phone reception and availability
• (cell and landline)
• Other communication devices in use

11
Client Flow

• One-way flow of traffic in clinic
• Provide assistance as necessary
• Monitor for bottlenecks
• Keep families together
• Adjust assignment as requested in order to remedy
  problems

12
(No Transcript)
13
Signage In Use

• Direct clients through site
• Designate areas of clinic/EDS/POD
• Provide information instruction

14
Safety Security Plan

• Goal Ensure safe and secure clinic operations
  for staff, clients, and supplies
• Staff lead for safety and security (ICS) Safety
  Officer, police, fire, EMS, behavioral health
  other staff assigned
• ALL staff have a role and responsibility in
  safety and security
• Identify how to report concerns and access help

15
Safety Security Plan (cont.)

• Client considerations children, individuals in
  need of assistance...
• Be alert to problems frustration, agitation,
  anxiety (diffuse and distract, get help before
  escalation)
• Security of supplies needles, syringes,
• vaccine/medication, biohazards
• Security for staff belongings handbags, phones,
  etc

16
Emergencies

• Adverse reactions to vaccine/medication
• Other medical/behavioral emergencies
• Police/security emergencies
• Fire emergencies

17
Emergency Response

• Onsite emergency responders (whenever possible)
• Community resources (ex. Fire, EMS, Police, local
  hospital, etc)
• Emergency medical equipment, supplies, and
  standing orders
• Orient staff to location and use
• Phone availability, location and 911 access

18
Site and Planis divided into two sections

• Clerical, Safety and Security assignments and
  stations
• Clinical/Dispensing
• assignments and stations

19
Clerical, Safety Security Areas

• These areas encompass all staff and
• assignments outside the clinical/
• dispensing area

20
Staff Assignments in Clerical, Safety
Security Area

• Registration staff
• Clinic flow staff
• Forms collection data entry staff
• Observation and exit staff
• Interpreter(s)
• Escort(s)
• Behavioral health staff

• EDS Director/Incident Commander
• Clerical, Safety Security Supervisor(s)
• Safety Security staff /Safety Officer
• Staff registration person(s)
• Parking staff
• Greeter(s)
• Screener(s)

21
Clinical/Dispensing Area

• Area designated for vaccine or medication
  administration/dispensing
• Limit access to this area to
• protect privacy and confidentiality
• reduce noise and confusion
• support security and safety plans

22
Staff Assignments in Clinical/Dispensing Area

• EDS director/Incident Commander
• Medical Director
• Clinical supervisor, other direct supervisors
• Vaccine/medication manager
• Vaccinator/medication dispenser

• Vaccinator /dispensing assistant
• Clinical runner(s)
• Observation staff
• Emergency response staff
• Behavioral health staff
• Interpreter(s)
• Escort(s)

23

• Clerical, Safety Security Staff
• Just-in-Time Training

24
Clerical, Safety Security StaffTraining
Objectives

• Describe job assignments
• Describe station assignments
• Identify direct supervisor
• Describe details of clinic flow
• Identify method of communicating with Direct
  Supervisor and other staff
• Identify procedure to access supplies

25
Clinic Flow Details

• Parking/drop-off
• Entry
• Orientation
• Registration
• Vaccination/dispensing
• Observation
• Exit

26
Parking and Entry Area

• Function of area
• Provide drop-off for mobility impaired
• Escorts/assistance as needed
• Parking instruction
• Signage and info on target population
• Direct clients to entry

27
Registration/Orientation Area

• Function of area
• Distribute forms and provide assistance as
  needed,
• provide relevant Information and instructions
• Disease Fact Sheet
• Vaccine/medication administration form
• Vaccination Information Statements (VIS)
• Medication information sheet
• Screening form
• Billing information form (if applicable)
• Consent form (if applicable)
• Release of information form (if applicable)

28
Screening Area

• Function of area
• Screening for contraindications or precautions to
  
• vaccine/medication
• Assure appropriate forms are complete
• Assist with questions or refer to Direct
  Supervisor
• Request an interpreter if needed
• Protect confidentiality and privacy
• Only ask need to know information for safe
  administration of vaccine/medication

29
Clinical/Dispensing Area

• Restrict access to clients ready for
  vaccine/medication, their family, and staff
  assigned to this area
• Assure appropriate forms are complete before
  client enters dispensing/clinical area
• Direct clients to appropriate station

30
Observation Area

• Function of area
• Observe clients for 15-20 minutes after
• vaccination
• Especially if first time receiving vaccine
• Be familiar with and monitor for signs and
  symptoms of adverse reactions
• Provide educational materials, entertainment and
  refreshments (as available)

31
Exit Area

• Function of area
• Collect forms (if applicable)
• Ensure client leaves with essential documents
• Answer questions and report concerns
• Complete exit survey (if applicable)

32

• Clinical/Dispensing
• Staff
• Just-in-Time Training

33
Clinical/Dispensing StaffTraining Objectives

• Describe job assignments
• Describe station assignments
• Identify Direct Supervisor
• Review standing orders
• Locate emergency supplies
• Describe screening, client education and required
  documentation
• Describe contraindications/precautions
• Describe signs/symptoms of adverse reaction

34
Vaccine/Medication on Hand

• Manufacturer and formulation
• Review package insert
• Review VIS (if applicable)
• Other resources

35
Standing Orders

• Vaccine/medication (specific)
• Standing Orders
• Emergency Standing Orders
• Current and signed by Medical Director
• Location of orders on-site
• Location of emergency equipment, medications and
  supplies

36
Vaccine Information Statement (VIS)

• Vaccine specific
• Required by federal law
• Must be current edition (unaltered)
• Must be given before each dose
• Conveys risks and benefits of vaccine
• Available in multiple languages
• Provide opportunity for questions

37
Medication Information Sheet

• Name and formulation of medication
• Directions for use
• Dosing administration information
• Signs symptoms of adverse reaction/side effects
• Contact information for questions or concerns

38
Screening

• Vaccinator/dispenser responsible for final review
  of screening questions
• Protect confidentiality and privacy
• Only ask need to know information for safe
  administration of vaccine/medication
• Utilize interpreter if needed

39
Required Documentationfor Administration of
Vaccine

• Patients name
• Vaccine name, manufacturer, lot number and
  expiration date
• Publication date on VIS, date VIS was given
• Anatomical site, route and dose
• Date vaccine administered
• Vaccinators name, signatures, credentials and
  address (on file)
• Clinic name, address and contact person
• Signed consent is only required for children when
  a parent/guardian is not present

40
Documentationfor Dispensing Medication

• Patients name (date of birth)
• Age and weight (children)
• Medication name, manufacturer, lot number and
  expiration date
• Route and dose
• Date administered
• Medication administrator/dispensers name,
  signatures, credentials and address (on file)
• Clinic name, address and contact person
• If using Head of Household model names, ages,
  weight (children), medication allergies of family
  members

41
Documentation

• Must be
• Legible
• Accurate
• Complete

42
Vaccinator/Dispenser Responsibilities

• Be informed about storage, handling, preparation,
  administration and contraindications of
  vaccine/medication
• Review package insert and standing orders
• Relay information on risks and benefits of
  accepting or refusing vaccine/medication
• Screen for contraindications and precautions
  prior to administration
• Seek Direct Supervisor when needed
• Be mindful of security and safety of vaccine/
  medication, sharps and biohazards

43
Responsibilities (cont.)

• Understand document used to record
• administration/dispensing
• Complete required documentation accurately and
  legibly
• Be able to access and use emergency equipment
• Hold current licensure and/or certification
• Report adverse events (VAERS)
• Report vaccine/medication errors

44
Vaccine Storage and Handling

• Maintain cold chain at your station
• Keep vaccine on a cool pack or in a cooler
• Protect vaccine from exposure to light
• If vaccine is pre-drawn at clinic, dispose unused
  pre-drawn syringes at end of day
• Label opened unused vials with date and your
  initials
• Go to Vaccine Manager or Direct Supervisor with
  questions, concerns, problems or need for
  additional vaccine

45
Medication Storage and Handling

• Per package insert and manufacturers
  instructions
• Be mindful of safety and security of medication
  at your station

46
Administration/DispensingBest Practice

• Use 5 Rights of Medication Administration
• Right Patient verify name and age, screen for
  contraindications and precautions
• Right Drug check label, verify appropriate for
  age and by manufacturer
• Right Dose determined by age or weight
• Right Route IM, subcutaneous, PO, intranasal
• Right Time refer to dosing schedules and minimum
  intervals between doses

47
Vaccination/Dispensing Station Supplies

• Adhesive tape
• Hand sanitizer
• Gloves (latex free)
• Sharps/biohazard container
• Appropriate paperwork/pens
• Tissue and paper towels
• Trash container/bags
• Gauze

• Vaccine/medication
• Container for vaccine/medication with cold pack
  (if appropriate)
• Safety syringes/needles (different sizes)
• Alcohol wipes
• Bandages (latex free)

• Ask Clinical Runner for additional supplies

48
Vaccine/Medication Errors

• Report error and incidents immediately to Direct
  Supervisor
• Monitor client for adverse reaction (if
  appropriate)
• Frequently seen errors
• Wrong vaccine or medication
• Wrong dose for age
• Wrong site, route or needle length
• Administering expired/recalled vaccine
• Wrong time, errors in spacing of doses
• Report vaccine/medication administration errors
  to the Institute for Safe Medication Practices
  www.ismp.org

49
ISMPInstitute of Safe Medication Practices

• Report medication/vaccine administration errors
  to ISMP online at
• www.ismp.org
• Institute for Safe Medication Practices200
  Lakeside Drive Suite 200Horsham, PA
  19044-2321Phone [phone]Fax [phone]

50
VAERSVaccine Adverse Event Reporting System

• Report all clinically significant post-
• vaccination events via online, mail, phone
• or fax
• www.vaers.hhs.gov
• VAERS
• P.O. Box 1100,
• Rockville, MD 20849-1100
• 1-800-338-2382 (phone)
• 1-877-721-0366 (fax)

51
Safety Considerations

• Safety syringes be familiar with product on hand
• Post vaccination/administration observation for
  15 20 minutes
• Security of vaccine, medication, needles,
  biohazard/sharps container
• Needle Stick Policy
• Blood Borne Pathogens Policy
• Hand hygiene, sanitizer
• Gloves and personal protective equipment (PPE)

52
Observation Area

• Function of area
• Observe clients for 15-20 minutes after
• vaccination/medication
• Be familiar with and monitor for signs and
  symptoms of adverse reactions
• Provide educational materials, entertainment and
  refreshments (as available)

53
Clinical Resources

• Package inserts
• Standing orders
• Quick reference guides
• Drug handbook
• Clinic Manual
• Epidemiology and Prevention of Vaccine-Preventable
  Diseases (The Pink Book) from the CDC
• Red Book 2009 Report of the Committee on
  Infectious Diseases from the American Academy of
  Pediatrics

54
Please join us for the other training modules!

• Vaccine Management, Storage and Handling
  November 16th, 300-400
• Available online soon!
• Vaccine and Medication Preparation and
  Administration
• Planning a Clinic/EDS/POD

7/25/2015
54
55
The End!

• THANK YOU!
• Questions?