Massachusetts Department of Public Health Training Module

1. 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 Massachusetts Department of Public HealthTraining Module MDPH

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) MDPH

3. All-Staff Briefing Purpose: To inform and orient all staff working at a clinic/EDS/POD on the operations plan MDPH

4. 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) MDPH

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 MDPH

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 MDPH

7. Reason For Clinic/EDS/POD • The infectious disease or agent • The mode of transmission (PPE and precautions recommended) • The treatment or prophylaxis MDPH

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 MDPH

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 MDPH

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 MDPH

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 MDPH

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13. Signage In Use • Direct clients through site • Designate areas of clinic/EDS/POD • Provide information & instruction MDPH/CHA

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 MDPH

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… MDPH

16. Emergencies • Adverse reactions to vaccine/medication • Other medical/behavioral emergencies • Police/security emergencies • Fire emergencies MDPH

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 MDPH

18. Site and Planis divided into two sections: • Clerical, Safety and Security assignments and stations • Clinical/Dispensing assignments and stations MDPH

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

20. 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 Staff & Assignments in Clerical, Safety & Security Area MDPH

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 MDPH

22. 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) Staff & Assignments in Clinical/Dispensing Area MDPH

23. Clerical, Safety & Security Staff Just-in-Time Training MDPH

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 MDPH

25. Clinic Flow Details • Parking/drop-off • Entry • Orientation • Registration • Vaccination/dispensing • Observation • Exit MDPH

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 MDPH

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) MDPH

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 MDPH

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 MDPH

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) MDPH

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) MDPH

32. Clinical/Dispensing Staff Just-in-Time Training MDPH

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 MDPH

34. Vaccine/Medication on Hand • Manufacturer and formulation • Review package insert • Review VIS (if applicable) • Other resources MDPH

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 MDPH

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 MDPH

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 MDPH

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 MDPH

39. 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 MDPH

40. 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 MDPH

41. Documentation Must be: • Legible • Accurate • Complete MDPH

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 MDPH

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 MDPH

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 MDPH

45. Medication Storage and Handling • Per package insert and manufacturer’s instructions • Be mindful of safety and security of medication at your station MDPH

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 MDPH

47. 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 Vaccination/Dispensing Station Supplies Ask Clinical Runner for additional supplies MDPH

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 MDPH

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: 215-947-7797Fax: 215-914-1492 MDPH

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) MDPH