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Massachusetts Department of Public Health

Training Module

ALL-STAFF BRIEFING&

JUST-IN-TIME TRAININGFor a Clinic, EDS or POD

Presented by:Barbara Coughlin, RNHealth EducatorMassachusetts Department of Public HealthNovember 15, 2010

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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)

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All-Staff Briefing

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

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Sign-In / Sign-Out

Sign-in on arrival Record arrival time, name, address and other

info as requested Receive job assignment & station Receive supervisor’s 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)

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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

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Incident Command System (ICS)

Abbreviated version of ICS: Flexibility Scalability Span of control

Establishes chain of command All you need to know:

direct supervisor

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Reason For Clinic/EDS/POD

The infectious disease or agent The mode of transmission

(PPE and precautions recommended) The treatment or prophylaxis

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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

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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

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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

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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

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Orientation/Paperwork

Registration/Forms Review

Vaccine Administration

Medical Aid and/or Support

Medical Screening

Forms Collection

Important Note: Individuals may be sent to Medical Aid and/or Support for assistance at any point in the process. In addition, health education may be taking place at many points in the process.

Start Here

Greeter/Initial Triage

Exit

MedicalScreening

Observation(if needed)

Orientation/Paperwork

Registration/Forms Review

Vaccine Administration

Medical Aid and/or Support

Medical Screening

Forms Collection

Important Note: Individuals may be sent to Medical Aid and/or Support for assistance at any point in the process. In addition, health education may be taking place at many points in the process.

Start Here

Greeter/Initial Triage

Exit

MedicalScreening

Observation(if needed)

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Signage In Use

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

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Safety & Security PlanGoal: 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

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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…

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Emergencies

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

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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

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Site and Planis divided into two sections:

Clerical, Safety and Security assignments and stations

Clinical/Dispensing assignments and stations

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Clerical, Safety & Security Areas

These areas encompass all staff andassignments outside the clinical/ dispensing area

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Staff & Assignments in Clerical, Safety & Security Area

EDS Director/Incident Commander

Clerical, Safety & Security Supervisor(s)

Safety & Security staff /Safety Officer

Staff registration person(s)

Parking staff Greeter(s) Screener(s)

Registration staff Clinic flow staff Forms collection &

data entry staff Observation and exit

staff Interpreter(s) Escort(s) Behavioral health staff

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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

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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)

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Clerical, Safety & Security Staff

Just-in-Time Training

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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

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Clinic Flow Details

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

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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

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Registration/Orientation AreaFunction 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)

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Screening AreaFunction 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

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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

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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)

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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)

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Clinical/Dispensing Staff

Just-in-Time Training

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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

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Vaccine/Medication on Hand

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

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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

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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

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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

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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

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Required Documentationfor Administration of Vaccine Patient’s 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 Vaccinator’s 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

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Documentationfor Dispensing Medication Patient’s name (date of birth) Age and weight (children) Medication name, manufacturer, lot number

and expiration date Route and dose Date administered Medication administrator/dispenser’s 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

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Documentation

Must be: Legible Accurate Complete

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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

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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

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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

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Medication Storage and Handling

Per package insert and manufacturer’s instructions

Be mindful of safety and security of medication at your station

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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

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Vaccination/Dispensing Station Supplies Vaccine/medication Container for

vaccine/medication with cold pack (if appropriate)

Safety syringes/needles (different sizes)

Alcohol wipes Bandages (latex

free)

Adhesive tape Hand sanitizer Gloves (latex free) Sharps/biohazard

container Appropriate

paperwork/pens Tissue and paper

towels Trash container/bags Gauze

Ask Clinical Runner for additional supplies

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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

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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 200

Horsham, PA 19044-2321Phone: 215-947-7797

Fax: 215-914-1492

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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 20849-11001-800-338-2382 (phone)

1-877-721-0366 (fax)

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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)

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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)

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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

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Please join us for the other training modules!

Vaccine Management, Storage and Handling: November 16th, 3:00-4:00

Available online soon! Vaccine and Medication

Preparation and Administration Planning a Clinic/EDS/POD

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The End!

THANK YOU!

Questions?