Setting Up for Vaccination Services

1 VaccinatingAdults:A Step-by-Step GuideImmunization action coalition we could sendout a prefabricated vaccina-tion station filled with inventory that you could simply install in your practice, we would. This chap-ter is the next best thing. It provides information in one location about many of the details you shouldknow. What you learn will help prepare your facilityand your personnel for the preventive healthcareservice you will soon be providing or this chapter s guidance will save you timeand help you plan. Most of the supplies you willneed come from just a few sources. You will have todecide who will place orders, where the new sup-plies will be stored, who will use and maintain what,and when your Setting will be ready to begin vacci-nating.

2 To keep things in perspective, remember: youare simply adding a new and important service, notrevamping or restructuring your entire workplace. Obtain support and cooperation from clinic staff and managementIntegrating a new activity into an already busy setof responsibilities can be challenging. You know it sthe right thing to do, but you may need to convinceothers in your healthcare Setting . It is critical thatyou obtain support from the management of yourfacility. You should take the time you need to ensureeveryoneon your staff is comfortable with and sup-portive of this new activity. A combination of meet-ings and follow-up written communications can be effective in gaining support and making certainstep2: Setting Up for Vaccination ServicesIStep-by-Step.

3 Setting Up Tasks Obtain support and cooperation from clinic staff and management Seek out community resources Assign a Vaccination coordinator and a back-up for that person Plan workflow and workspace Determine how and where vaccines will be stored, and purchaseappropriate vaccine storage and temperature monitoring equipment Purchase vaccine administration supplies Purchase emergency response supplies Determine who can provide vaccinations in your Setting Arrange for staff training Organize Vaccination paperwork and reference materials Create standing orders documents for times when a supervisingclinician is not available to write orders Order vaccines Yes, do this last!You should take the time you need to ensure everyoneon your staff iscomfortable with and supportive of this new gets the same information.

4 Frontline staff,both medical and clerical, will likely be the mostheavily affected. They will need to receive positivereinforcement that Vaccination is a worthwhile andimportant service. As soon as possible, representa-tives from each group (management, financial,insurance, medical, nursing, clerical, etc.) shouldbecome involved in working meetings to discussthe following issues: How can you set up a system that ensures allpatients or clients are assessed and offeredappropriate vaccines? Will vaccines be offered every day or only duringdesignated times? Will evening vaccinationtimes be available? Can patients come in for Vaccination only? What paperwork or electronic record system isnecessary for this activity?

5 How will patient tracking be done? Who is responsible for monitoring the tempera-tures in vaccine storage units? Who will be responsible for management ofinventory and ordering vaccines and supplies? How and by whom will reimbursement for vacci-nation Services be obtained?Seek out community resources Once you have a basic idea of how you d like vaccineservices to be conducted in your healthcare Setting ,it s time to seek out expertise from others within yoursetting or from outside sources. If you re part of amedical facility, you can learn from those who arealready involved in routine Vaccination delivery ( ,pediatricians, family physicians, internists, nurseclinicians, and, of course, the nurses who work withthem).

6 If you re not part of an organization withexperienced vaccinators available to help you, con-tact staff at your local or state health list of their key immunization program personnelis available at Assign a Vaccination coordinator and a back-up for that person Most likely, you will not need to hire new staff to setup or administeryour vaccinationprogram. But itis critical to des-ignate someoneas the vaccina-tion also is impor-tant to assign someone to be the back-up personto this coordinator. The coordinator s responsibilitiesmight include ordering and maintaining an inven-tory of vaccines, syringes, and other supplies; devel-oping or acquiring screening checklists, proceduralguidelines, and other protocols for vaccinators and assuring competence of staff; ensuring properstorage and handling of the vaccine; monitoringcompliance with several recordkeeping require-ments; and evaluating the program.

7 Both the vacci-nation coordinator and the back-up person can gethelp with these tasks by reviewing the Guideandworking with your organization s medical :A Step-by-Step GuideImmunization action coalition 2: Setting Up for Vaccination ServicesIt is critical to designatesomeone as the vaccinationcoordinator. It also is important to assign someoneto be the back-up personto this workflow and workspaceDecide in advance where the vaccinations willactually take place. If you do not plan to use examrooms, plan for a waiting area and a vaccinationarea. Make sure there is good lighting, ventilation,and a sink for handwashing. Consider where youwill prepare and fill the syringes with certain that there is adequate space to placesharps containers for used needles close to thelocation where the vaccinations will be there space for an additional refrigerator andfreezer unit if needed?

8 Are there cabinets or shelvesfor storing everything from needles to alcohol wipes?What about shelf space and slots or trays forforms, informational materials, and record cards?How will data entry be handled? If it is conductedin an exam room, you may need to factor in spacefor data entry tools such as computers, bar codescanners, how and where vaccines will be stored, and purchase appropriatevaccine storage and temperature monitoring equipmentThe Centers for Disease Control and Prevention(CDC) strongly recommends you have separaterefrigerator and freezer units to properly store yourvaccines. These units should be dedicated to vac-cine storage. They must not be used for any pur-pose or product beyond the storage of pharmaceu-ticals and biological products.

9 That means no stafflunches or beverages! Aside from possible contam-ination issues from food being stored in the sameunit, frequent opening and closing of the doorswill contribute to temperature fluctuations. (SeeStep 3:Vaccine Storage and Handlingfor additionaldetails.) Your refrigerator and freezer do not haveto come from a medical supply company. But youdo want to be sure you get quality units that canreliably maintain vaccinestorage temperatures. As previously noted,CDC recommends stand-alone refrigerators andfreezers for vaccine storage. If you must usea combination refrigerator/freezer unit, vaccinesshould be stored only in the refrigerator compart-ment, with the freezer not used for vaccine s because combination units are less capableof simultaneously maintaining proper storage temperatures in both the refrigerator and freezercompartments.

10 A combination freezer set for propervaricella storage temperature can inadvertentlycause the refrigerator to be too cold and risk freezingrefrigerated vaccines. (note:Small dormitory-style or bar-style combined refrigerator-freezers areneveracceptable for vaccine storage. Studies haveconfirmed that these units pose a significant riskfor freezing vaccine.) To be sure the refrigerator and freezer are function-ing properly, you will need to invest in appropriatethermometers. Details about refrigerator and thermometer selec-tion can be found in Step 3: Vaccine Storage andHandling. For now, be aware that someone (and aback-up person) must be assigned the responsibil-ity to monitor and record temperatures at leasttwice a vaccine administration suppliesDepending on the activities your clinic or settingcurrently performs, you already may have many ofthe items needed for vaccine administration.