THE CHILDREN’S TRUST

1. THE CHILDREN’S TRUST Support Staff Training 2009 Sandra Smith, RN Patricia Onley-Waite, RN

2. SUPPORT STAFF GOALS • Accurate record keeping/maintenance • Determining client for VFC Program eligibility • Manage electronic record database • Maintain adequate vaccine supply on hand • Maintain adequate office/medical support supply on hand • Maintain current knowledge onimmunization guidelines/mandates

3. DOCUMENTATION • Prepare medical record • Obtain accurate demographical information • Accurately transcribe immunization history • Manual immunization information = electronic immunization information • Determine VFC eligibility • Maintain real time manual and electronic immunization data to prevent errors • Make readily available information for Health Department staff Co-CASA/AFIX Reviews

4. IMMUNIZATION INFORMATION • Obtain accurate historical immunization • Information must be from credible source (medical record, personal immunization record book with a doctor’s office stamp, titers) • Cannot be word-of-mouth • May need to be translated to English (cannot be maintained in any other language in the USA) • Input accurate data into electronic database (“junk in-junk out”)

5. WHY? • Reminder/recall system • Outbreak control • Decreases vaccine wastage • Decreases missed opportunities to vaccinate • Decreases possibility of duplications

6. PROBLEMS WITH HISTORICAL IMMUNIZATION RECORDS • Roman numerals (XIV, IV, etc.) • Reversed dates (day/month/year) • Foreign languages (have to translate what type of vaccine was administered) • Vaccine administered is not required in the US, so still missing vaccines • Date written is prior to the child’s first birthday

7. VFC PROGRAM REQUIREMENTS • Must practice the Standards for Child and Adolescent Immunization Practices • Must follow the Advisory Committee on Immunization Practices’ (ACIP) guidelines • Highly encouraged to adopt the Florida State Health Online Tracking Systems (FLSHOTS)/”The Registry” • Participate in routine Co-CASA/AFIX Reviews to ensure that all VFC Program requirementsare being followed

8. WHAT IS THE VFC PROGRAM? The Vaccines for Children Program is a federally-funded program established by the Centers for Disease Control and Prevention (CDC) to allow participating medical providers to offer free vaccines to eligible children between the ages of 0 months through 18 years of age.

9. WHAT IS VFC ELIGIBILITY? A child is determined to be “VFC Eligible” when he/she is one of the following: - Eligible for Medicaid - Uninsured - Underinsured - American Indian - Alaskan Native

10. WHAT IS CO-CASA/AFIX? Co-CASA/AFIX is a database-driven assessment tool known as Comprehensive-Clinic Assessment Software Application that is computer-based to review a medical provider’s accuracy in following the ACIP-driven immunization schedule for persons 0-6 years of age. It is used along with the AFIX strategies known as Assessment, Feedback, Incentives and eXchange of information provided to the medical providers in means of improving the quality of immunization practices noted per the assessment so that all children are completely and appropriately immunized on time per the CDC-mandated guidelines. These tools (Co-CASA/AFIX) may be tailored to be used for any age. However, at this time, the CDC has been focusing on children 2 years of age and under as children who have successfully completed their primary immunization series on or before their second birthday are at least 90% likely to receive their booster vaccines for Kindergarten and Seventh grade entry.

11. WHAT IS FLSHOTS? The Florida State Health Online Tracking System (FLSHOTS), also known as “The Registry,” is a computerized database for warehousing immunization records of anyone who has received immunizations through any of the 67 County Health Departments. It has expanded to include the military and is now including medical providers who participate in the VFC Program. The goal is to accumulate and store the immunization records of all residents and visitors to the State of Florida and link this database to the national registry/information system. Ultimately, this will reduce the cost of vaccines paid by the CDC by limiting/eliminating vaccine wastage, managing vaccine inventories, determining and controlling outbreaks, reducing missed opportunities to vaccinate and educating providers on the strategies to improve their immunization rates thus ensuring a protected community from communicable disease.

12. REQUIRED DOCUMENTS • DH 680 (“Blue Form”) – DH 680 is the Florida Certification of Immunization used to record each child’s immunization information from birth through 18 years of age • DH 3040 (“Yellow Form”) – DH 3040 is the State of Florida School Entry Health Exam used to record each child’s physical health status including any possible Tuberculosis risk • Personal Immunization Record Book - provided to each client who receives immunization services and updated after each vaccine administered. This record belongs to the client

13. LEFT SIDE Demographic Form HIPAA Form Consent Form Billing Form Copy of Identification RIGHT SIDE DH 687 Electronic DH 687 MEDICAL RECORD

14. WHAT IS THE VIS? The Vaccine Information Statement (VIS) is an informational sheet educating the client or legal representative of a minor of the benefits and risks of a vaccine. This form is created by the Centers for Disease Control and Prevention (CDC) in multiple languages besides English (E). In Florida, we mainly add Spanish (S) and Haitian Creole (C). This is in accordance with Federal Law: 42 U.S.C. §300aa-26.

15. FEDERAL LAW It is mandated by federal law that every provider who administers vaccines must give the VIS of each vaccine being administered at every visit no matter how many times the vaccine is administered. Along with the VIS, the provider must explain the benefits and risks and ensure that the client or legal representative understands all that is being explained to them and is allowed to ask questions thereafter. Both the VIS and the verbal information must be in the client’s primary language – the language that they read and/or speak primarily and comfortably. The VIS must also be the most current version available – they are all dated.

16. CURRENT VIS FORMS: COMMON VACCINES • Multi-VIS 9/18/08 (E) – DTaP/IPV/Hib/PCV7/HBV/Rota • DTaP 5/17/07 (E/S) – including pediatric DT • Flu 7/24/08 (E/S) – Inactivated/Live Attenuated Viruses • HAV 3/21/06 (E/S) • HBV 7/18/07 (E/S) • Hib 12/16/98 (E/S/C) • HPV 2/2/07 (E/S/C) • IPV 1/1/00 (E/S/C) • MEN 1/28/08 (E) - interim • MMR 3/13/08 (E) • PCV7 12/19/08 (E/S/C) • PPSV 7/29/97 (E/S/C) • Rabies 1/12/06 (E/S) • Rota 8/28/08 (E) • Shingles 9/11/06 (E/S) – Herpes Zoster • Td/Tdap 11/18/08 (E/S/C) • VZV 3/13/08 (E)

17. CURRENT VIS FORMS: EXOTIC VACCINES • Polio (IPV) 1/1/00 (E/S/C) • Japanese Encephalitis (JE) 5/11/07 (E) • Typhoid 5/19/04 (E/S) • Yellow Fever (YF) 11/9/04 (E/S)

18. CURRENT VIS FORMS: BIOTERRORISM PREPAREDNESS • Anthrax 4/24/03 (E) • Smallpox (Vaccinia) 11/15/03 (E) • Used mostly by military personnel, specific laboratory staff and in bioterrorism events

19. VIS DOCUMENTATION POLICIES • Document providing VIS form in permanent medical record • Note which form was given • Date given • Publication date of the form • The name/address/title of the person who administered the vaccine • The vaccine administration date • The vaccine manufacturer • The vaccine lot number • You must use the CDC-version of the VIS form • You cannot design/create your own version of the form, nor can you change anything on the form • In accordance with Federal Law 42 US Code 300aa-25

20. VIS RESOURCE SITES • Vaccine Information Statement Home Page: www.cdc.gov/vaccines/pubs/vis/default.htm • “It’s Federal Law!” (by N. A. Halsey, M.D.): www.immunize.org/catg.d/p2027.pdf • How to Use VISs (Immunization Action Coalition): www.immunize.org/vis/vis_howto.asp • CDC Contact Information: 1-800-CDC-INFO (232-4636)

21. CDC RESOURCES • National Center for Infectious and Respiratory Diseases (NCIRD) formerly known as the National Immunization Program (NIP): http://www.cdc.gov/vaccines/default.htm • Standards for Child and Adolescent Immunization Practices: www.cdc.gov/nip/publications • General Recommendations on Immunizations(12/1/06)http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm • Epidemiology and Prevention of Vaccine Preventable Diseases (“Pink Book” updated March 2008 – 10th edition’s 2nd printing): www.cdc.gov/nip/publications • Vaccine Information Statements: www.cdc.gov/nip/publications • Co-CASA Home Page:http://www.cdc.gov/vaccines/programs/cocasa/default.htm • AFIX Home Page:http://www.cdc.gov/vaccines/programs/afix/default.htm

22. BUREAU OF IMMUNIZATION RESOURCES • Bureau of Immunization Home Page:http://www.doh.state.fl.us/disease_ctrl/immune/index.html • Information for Providers: http://www.immunizeflorida.org/providers/index.htm • Vaccines for Children Program Home Page: http://www.immunizeflorida.org/vfc/index.html • FLSHOTS Home Page: http://www.flshots.org/ • Co-CASA Home Page:http://www.immunizeflorida.org/providers/casa.htm

23. COUNTY HEALTH DEPARTMENT RESOURCES • Miami-Dade County Health Department (MDCHD) Home Page: www.dadehealth.org Telephone: 305-324-2400 (main number) • School Health Program (SHP): www.dadehealth.org/school/SCHOOLprogram.aspTelephone: 786-845-0222 • Special Immunization Program (SIP): www.dadehealth.org/immuniz/IMMUNIZintro.asp Telephone: 786-845-0550 (for clinic appointments only) • Office of Epidemiology (EPI): http://www.dadehealth.org/discontrol/DISCONTROLintro.asp Telephone: 305-470-5660 (use this number to contact SIP)