Massachusetts Department of Public Health Training 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 4/20/2017 MDPH

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) 4/20/2017 MDPH

All-Staff Briefing Purpose: To inform and orient all staff working at a clinic/EDS/POD on the operations plan “Hello and thank you” 4/20/2017 MDPH

Sign-In / Sign-Out Sign-in on arrival Sign-out on departure 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) 4/20/2017 MDPH

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 4/20/2017 MDPH

Incident Command System (ICS) Abbreviated version of ICS: Flexibility Scalability Span of control Establishes chain of command All you need to know: direct supervisor 4/20/2017 MDPH

Reason For Clinic/EDS/POD The infectious disease or agent The mode of transmission (PPE and precautions recommended) The treatment or prophylaxis 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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Signage In Use Direct clients through site Designate areas of clinic/EDS/POD Provide information & instruction 4/20/2017 MDPH/CHA

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 4/20/2017 MDPH

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… 4/20/2017 MDPH

Emergencies Adverse reactions to vaccine/medication Other medical/behavioral emergencies Police/security emergencies Fire emergencies 4/20/2017 MDPH

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 4/20/2017 MDPH

Site and Plan is divided into two sections: Clerical, Safety and Security assignments and stations Clinical/Dispensing assignments and stations 4/20/2017 MDPH

Clerical, Safety & Security Areas These areas encompass all staff and assignments outside the clinical/ dispensing area 4/20/2017 MDPH

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) 4/20/2017 MDPH

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 4/20/2017 MDPH

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) 4/20/2017 MDPH

Clerical, Safety & Security Staff Just-in-Time Training 4/20/2017 MDPH

Clerical, Safety & Security Staff Training 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 4/20/2017 MDPH

Clinic Flow Details Parking/drop-off Entry Orientation Registration Vaccination/dispensing Observation Exit 4/20/2017 MDPH

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 4/20/2017 MDPH

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) 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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) 4/20/2017 MDPH

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) Identify staff assigned to this area 4/20/2017 MDPH

Just-in-Time Training Clinical/Dispensing Staff Just-in-Time Training 4/20/2017 MDPH

Clinical/Dispensing Staff Training 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 4/20/2017 MDPH

Vaccine/Medication on Hand Manufacturer and formulation Review package insert Review VIS (if applicable) Other resources Identify the vaccine or medication to be administered or dispensed, including formulation specific info Be aware of vaccine components Review population vaccine is approved for e.g. LAIV 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

Required Documentation for 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 4/20/2017 MDPH

Documentation for 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 4/20/2017 MDPH

Documentation Must be: Legible Accurate Complete 4/20/2017 MDPH

Vaccinator/Dispenser Responsibilities 4/20/2017 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 4/20/2017 MDPH 42 42 42

Responsibilities (cont.) 4/20/2017 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 4/20/2017 MDPH 43 43

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 4/20/2017 MDPH

Medication Storage and Handling Per package insert and manufacturer’s instructions Be mindful of safety and security of medication at your station 4/20/2017 MDPH

Administration/Dispensing Best 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 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 MDPH

ISMP Institute of Safe Medication Practices Report medication/vaccine administration errors to ISMP online at: www.ismp.org Institute for Safe Medication Practices 200 Lakeside Drive; Suite 200 Horsham, PA 19044-2321 Phone: 215-947-7797 Fax: 215-914-1492 4/20/2017 MDPH

VAERS Vaccine 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) 4/20/2017 MDPH

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) 4/20/2017 MDPH

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) 4/20/2017 MDPH

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 4/20/2017 MDPH

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 4/20/2017 4/20/2017 MDPH 54

The End! THANK YOU! Questions? 4/20/2017 MDPH