Part III: Documentation, Administration Fee, and Communicable Disease

1. Part III: Documentation, Administration Fee, and Communicable Disease

2. Objectives forDocumentation, Administration Fee and Communicable Disease • Participants will gain knowledge and enhance skills of current immunization issues by: • Understanding the different types of documentation required when administering vaccines. • Describing how and when an administration fee may be charged for giving state-supplied vaccines. • Identifying the steps of a communicable disease investigation.

3. Documentation

4. What do you have to document? • For each dose administered, you must record the following: • The manufacturer • Lot number • Date of administration • Administration site and route • Date the relevant current VIS was given • Date printed on the VIS, and • Name, address and title of the provider who administered the vaccine

5. Vaccine Administration Record

6. Vaccines Administered Log

7. Exemptions to Immunizations • Only two types of exemptions from required immunizations available in NC: • Medical Exemption • Religious Exemption

8. Medical Exemption • Licensed NC physician • Does not require approval from the N.C. State Health Director.

9. Physician’s Request for Medical Exemption • Does require approval from the N.C. State Health Director.

10. Religious Exemptions • Written statement • bona fide religious beliefs and • opposition to the immunization requirements, • Does not need to be notarized or prepared by attorney • Does not need to be submitted to the State for review or approval.

11. Non-Religious Personal Belief • North Carolina does not accept philosophical exemptions for immunizations.

12. Refusal to Vaccinate Form

13. Certificate of Immunization • Name of the child • Name of the child's parent, guardian, or person responsible for the child obtaining the required immunization • Address of the child and the parent, guardian or responsible person • Date of birth of the child What should be included? • Sex of the child • Number of doses of the vaccine given • Date the doses were given • Name and address of the physician or local health department administering the required immunization and other relevant information

14. Why is the Certificate of Immunization Important? • Part of the OFFICIAL medical record • Required to enter school • Must show child received required vaccines

15. Translating Foreign Language Terms

16. Vaccine Accountability

17. What is Vaccine Accountability? • Vaccine accountability is a comparison of doses shipped to reported data • Accurately documenting by reports or in the NCIR vaccine that was administered, wasted/expired, transferred, or inventory on hand

18. What is the Importance of Vaccine Accountability? • Ensures sustainability of the North Carolina Immunization Program (NCIP) • Unreported vaccines affect: • Quality of data for clinical purposes • Assessment results • Funding

19. What is the Importance of Vaccine Accountability? • Vaccines are EXPENSIVE!! • Average inventory is $25,000 • Providers receive between 20 and 50,000 doses of state-supplied vaccine in a year • Yearly orders range from $400 to $1,000,000 • An order of just 10 doses of every vaccine is over $8,000

20. What Must be Accounted for? • All doses of any state-supplied vaccine: • That you administer • That fall on the floor and break • That you draw up but don’t need • That you transfer to or from another vaccine provider • That expire before you can use them

21. How are Doses Accounted for? • Doses in Inventory: • Inventory and properly reconciled • Doses Administered: • Record into the NCIR/on VALs • Doses Transferred: • Record transfers in the NCIR or Transfer Forms • Doses Expired/Wasted: • Report all expired/wasted vaccines

22. What about Wasted/Spoiled Vaccine? • Before wasting vaccine - Call the Immunization Branch • Document • Return vaccine

23. Transfers • Account for every dose shipped • Report transfers and wasted/expired vaccine

24. Borrowing/Replacing Policy • Must maintain adequate inventory • Borrowing can only occur when stock is inadequate because of: • Delayed shipment • Vaccine spoiled in transit • New staff calculated ordering time incorrectly • Vaccine must be replaced within 90 days

25. Documenting Borrowed/Replaced Vaccines • Must be documented on a Vaccine Borrowing report • Once vaccines are replaced, replacement date must be entered on the form • Forms must be held in the provider’s office for 3 years • Provider may have only one occurrence within a 12-month period

26. Who Should be Accountable? • Person who orders your vaccine • Physician who signs the agreement • Person who receives & stores your vaccine • Staff who administer vaccine • Person who records or enters doses given on VAL/in NCIR • Front office staff • EVERYONE!!!

27. Benefits of Accurate Child Specific Vaccine Administration Documentation • In case of recall or revaccination you will be able to accurately identify patients • Accurate recording could prevent unneeded repeated doses • Child specific documentation is shared with local health departments and becomes part of the patient’s immunization record

28. Questions about Documentation or Accountability?

29. Administration Fee

30. Charging for Administering NCIP Vaccines • Providers may not charge for state-supplied vaccines, but may charge an administration fee for giving vaccines.

31. Charging for Administering NCIP Vaccines Private Providers • If patients are paying the administration fee out-of-pocket, private providers may charge a maximum of the state Medicaid rate. • These rates change, and are posted on the Medicaid web site. • If a VFC patient/parent states an inability to pay, the fee must be waived, according to the vaccine agreement.

32. Charging for Administering NCIP Vaccines Local Health Departments • As of 2009, LHDs may charge (if they choose to) the patient an out-of-pocket administration fee unless: • The patient is uninsured or underinsured, and • The family income is below 200% of the federal poverty level. • If the patient/parent states an inability to pay, the fee must be waived, according to the NCIP vaccine agreement. • The maximum a LHD may charge a patient out-of-pocket is based on the state Medicaid rate.

33. Questions about the Administration Fee?

34. Vaccine Preventable Disease Control

35. Case Scenario: Rash x 3 days Temp = 102° Conjunctivitis Vaccine history- religious exemption Recent foreign travel

37. What Should You Do? Isolate Call the Local Health Department

38. Reporting Timeline 24 hours 7 days Report before laboratory confirmation Report to local health department Local health department reports to state health department

39. Why Report? To investigate Institute control measures Reduce exposure Limit spread

40. Common VPD Errors Serological testing for Pertussis Failure to Isolate Delay in contacting the LHD Delay in Treatment

41. Questions about Vaccine Preventable Disease Control?

42. Standards for Child and Adolescent Immunization Practices

43. The Standards • Availability of vaccines • Assessment of vaccination status • Effective communication about benefits and risks • Proper storage, administration and documentation • Implementation of strategies to improve vaccination coverage

44. Put Your Knowledge into Practice! • Question: What 7 things must you document for every dose of vaccine given?