Public Health Flu Clinic

Staff Orientation

November 1, 2010

Webinar Objectives

• Describe purpose and goals for November 10th

vaccination clinics

• Explain clinic operations:

– clinic layout: stations, client flow, staff positions

• Review staffing: Incident Command System (ICS)

– Roles, reporting structure, job action sheets (JAS)

• Provide staff instructions

• Answer questions

Clinic Purpose

• To provide free vaccines to Contra Costa County

community members to prevent disease

• To train Public Health staff to work at a mass

vaccination

Point of Dispensing

(POD)

Clinic Purpose Cont’d

• Our flu clinic PODs will be held at non-traditional

clinic sites, e.g., church, conference center,

library, school, etc.

Goals

• To vaccinate 9,000 community members in

one day at nine walk-through POD locations

throughout the county

• To help Public Health staff gain skills in mass

clinic POD operations

• To assist Public Health staff understand the

Incident Command System (ICS)

Flu Clinics• 9, free, walk-through POD sites, open to the public

1 pm to 7pm on Wednesday, Nov 10, 2010

Flu Clinics cont’d

• Clinics will offer free flu vaccine (shots or

nasal spray) to everyone age 6 months and

older

• Clinics will also offer free Tdap (tetanus,

diphtheria and pertussis/whooping cough)

and pneumococcal vaccine to those who are

eligible, while supplies last

Flu Clinics cont’d

• All are welcome

• Do not need to be a Contra Costa resident

(although we will ask for address)

• We have plenty of flu vaccine; we will shift

supplies around as needed

• FREE for everyone!

Staff Instructions

• You should have received a packet (email or

hard copy) with your reporting location and

role assignment (Job Action Sheet)

• Please read the information before arriving

• If unfamiliar with your

reporting location,

please map your route

to the site in advance

Staff Instructions Cont’d

• Site specific maps can be found at:

http://cchealth.org/topics/flu/vaccination.php

Staff Instructions Cont’d

• Please be on time! You should report to your

assigned location at the specified time

• If you cannot report to the location or at the

specified time, call 925-313-6740 immediately

• We love the environment too,

but please do not carpool to the clinic

(you may be asked to switch locations)

Staff Instructions Cont’d

• There will be a staff break room but no secure

area for valuables so please leave them at

home!

• Bring only what is essential and what you can

carry on your person (fanny pack, wallet, keys,

etc.)

Staff Instructions Cont’d

• Please dress comfortably, but professionally –

these are still clinics

• Wear sensible shoes!

• Breaks and a meal will be provided

(between 4 – 6 pm boxed lunches

will be served)

When You Arrive at the Clinic

• Proceed to the Staff Registration Area

• Check in and sign all required paperwork

• Put on your assigned vest

• Check the org chart

and identify:

– the POD Site Manager

– the Safety Officer

– your Supervisor

– your position

When You Arrive at the Clinic

Cont’d• Check in with your supervisor

• Find your station

• Review your JAS or other written station duties

• Participate in the all staff briefing

• If you need to be vaccinated,

let your supervisor know

During the Clinic

• Do your job to the best of your ability

• If you feel you are unable to perform your

assigned function, notify your supervisor

• Be pleasant and

professional to clients

and other staff

at all times

During the Clinic Cont’d

• You may be asked to switch assignments

during the clinic by your supervisor.

• You may not switch

assignments without

notifying your supervisor.

During the Clinic Cont’d

• If media shows up, immediately direct them

to the POD site manager

During the Clinic Cont’d

• Work out with your

supervisor your meal break

(30 minutes)

• If you get injured, let your

supervisor and the Safety Officer

know immediately!

At the End of the Clinic

• Check with the POD Site Manager for

instructions if there are still people waiting or

arriving at the clinic

• Assist with packing up supplies

• Do not leave early - you MUST sign out before

leaving the clinic

• Turn in your vest and complete feedback form

• Clinic Management Positions

– POD Site Manager (overall clinic functions and

media). Maintains contact with Public Health

Operations (597 Center Ave.)

– Medical Operations Leader (all clinical

operations)

– Non-Medical Logistics Leader (all non-medical

activities and supplies)

POD Site Organization

Incident Command System (ICS)

POD Site Organization Cont’d

Incident Command System (ICS)

POD Site Manager supervises:

– Medical Treatment Supervisor (first aid)

– Health and Safety Officer

– Medical Operations Leader (all clinical operations)

– Non-Medical Logistics Leader (all non-medical

activities and supplies)

POD Site Organization Cont’dIncident Command System (ICS)

– Medical Operations Leader – oversees clinical

services (screening and vaccination). Reports to

POD Site Manager.

– Non-Medical Logistics Leader - oversees client

registration, clinic flow, special assistance needs.

Reports to POD Site Manager.

POD Site Organization Cont’d

Incident Command System (ICS)

POD Site Organization Cont’dIncident Command System (ICS)

POD Flow

• There are 3 main areas of the POD:

– Client Check-In

– Screening

– Vaccination

• PODs are generally organized the same

although clinic leadership can alter depending

on site and situation

Clinic Flow – Client Check-In

Client Check-In

• Distribute the numbered form

– Screening questions

– Demographic information (name, dob, address)

– Nurse-only portion for screener/vaccinator

• As number is called, make sure form is filled

out completely and you can read it

• Answer questions – if you don’t know, ask

supervisor

Clinic Flow - Screening

Screening• Verify client’s identity and date of birth

• Screeners will review the answers to the screening questions for each client and decide which vaccines and formulations they will receive by CHECKING the box next to the vaccine

• Give client the Vaccine Information Statements for the vaccines they are getting

• If you have a question, ask the Screening Supervisor

Screening Form

Clinic Flow - Vaccination

Vaccination

• Verify client’s identity and which vaccines they

are receiving

• Prepare and administer the vaccines

• Fill out the form with the site where you gave

each vaccine and sign/date the form – KEEP THIS

FORM

• Fill out the IZ Record for the client with name and

dob and indicate which vaccines they got - give

this to the client

Supplies• There will be people assigned to monitor supplies

at the clinic

• We are sending plenty of vaccine and medical

supplies, as well as non-medical supplies to the

clinic

• The Vaccination Sup and Medical Supply Sup are

responsible for keeping track of vaccines used

and doses remaining and giving updates to the

Medical Operations Leader who will give to POD

Site Manager

Special Assistance Supervisor

• Responsible for ensuring that all clients

receive best service possible

• Spanish-speaking staff at every clinic

• Other languages available via Health Care

Interpreter Network (HCIN)

• Work with Medical Operations Leader to

identify family/disabled space in vaccination

area

Questions?

• We have described the generic clinic flow,

leadership structure and reporting instructions

• Anything we forgot?

• The next section will be on screening and

vaccination assignments

• Thank you! We look forward to seeing

everyone there!

Screening and Vaccination

Overview

Screening

The Screener has four primary responsibilities:

– Verify patient’s name and dob

– Decrease the possibility of an adverse event or

reaction due to receipt of a contraindicated

vaccine

– Insure appropriate vaccines are offered and

information given

– Answer questions and concerns of the person

receiving vaccine

Screening Questions1.Have you had a serious reaction to any vaccine in the past? If yes, which vaccine?

¿Ha tenido una reacción grave a alguna vacuna en el pasado? Si contestó Sí, ¿a cuál vacuna?

2.Do you have a latex allergy?

¿Es alérgico al látex?

3. Do you have a fever today?

¿Tiene fiebre hoy?

4.Are you allergic to eggs?

¿Es alérgico al huevo?

5.Is there a history of Guillain-Barre syndrome ( a severe paralytic illness)?

¿Hay antecedentes del síndrome Guillain-Barre (una enfermedad paralítica grave)?

6.Do you have any of the following medical conditions or risk factors? Circle all that apply.

¿Tiene alguna de las siguientes condiciones médicas o factores de riesgo? Dibuje un circulo sobre todos los que se apliquen.

Asthma/Wheezing Anemia/Blood problem Heart disease

Asma/Respiración ruidosa Anemia/Problema de la sangre Enfermedad cardiaca pulmón

Lung disease Kidney disease Diabetes HIV

Enfermedad del Enfermedad del riñón Diabetes VIH

Cancer treatment Long- term steroid use Neurological problem (epilepsy)

Tratamiento por cáncer Uso crónico de esteroides Problema neurológico (epilepsia)

Cochlear implant Smoker Alcoholism

Implante coclear Fumador Alcoholismo

Daily aspirin use (applies to children 18 years and younger) Other

Uso diario de aspirina (se aplica a menores de 18 años) Otro_______________________

7.Do you have close contact with a person who is in a bone marrow transplant unit?

¿Tiene contacto cercano con una persona que esta en (need Spanish translation)?

8.Have you received any live vaccines in the last month? MMR, Varicella (Chickenpox)

¿Ha recibido alguna vacuna viva durante el mes pasado? MMR (paperas, sarampión, rubéola), Varicela

9.Are you pregnant? If the answer is yes, how many weeks? _________

¿Está embarazada? Si contestó Sí, ¿cuántas semanas? _________

Screening

• Form is formatted in English and Spanish

• All patient sections must be completed and

signed by the pt or pts representative

• Nurse-only section is at the bottom

• Screeners will CHECK the vaccines to be given

• Screener will give Vaccine Information

Statements

http://www.immunize.org/vis/

Nurse-only Section of Form

Vaccines Available

• 6 different vaccines are available

– 4 formulations of Flu vaccine

– Pneumococcal (Pneumovax)

– Tdap

Flu Vaccine

• Flu IM preservative-free 0.25mL (6 months through 2 years)

• Flu IM preservative-free 0.5mL (pregnant women)

• Flu IM 0.5 mL multi-dose vial, preservative present (3 years and up)

• Flu LAIV (FluMist nasal spray) 2 years through 49 years, only healthy persons, not pregnant

Thimerosal

California law requires the use of thimerosal-

free vaccines for children < 3 years of age and

for pregnant women

This means vaccine must be packaged in a single

dose vial or pre-filled syringe for these groups

Pneumococcal

Prevents disease caused by Strep pneumoniae

Given IM

Ages 19 years and up for persons with certain health conditions

Everyone ages 65 years and older

Do not give if allergic

• Chronic pulmonary ds

• Smoker

• Chronic cardiac ds

• Blood disorders

• Asplenic

• HIV/AIDS

• Diabetes

• Alcoholism

• Cochlear implant

TdapPrevents tetanus, diphtheria and

pertussis

Given IM

Ages 10 years and up

No minimum interval between Td and Tdap

Do not give

• encephalopathy occurring within 7 days of previous dose of Td, DTaP

• Guillain-Barre syndrome

• Arthus reaction

Priority groups include:

Pregnant women in 2nd or 3rd

trimester

Caretakers of infants

Screening

1.Have you had a serious reaction to any vaccine in the

past? If yes, which vaccine?

Determine which vaccine and severity of reaction

• Anaphylaxis (NO vaccines refer to provider)

• Hx Guillain-Barre (NO Flu, NO Tdap)

• Hx Encephalopathy (NO Tdap)

• Hx Arthus reaction (NO Tdap)

Screening

2. Do you have a latex allergy?

Products containing latex are the prefilled single dose

units of preservative free flu vaccine for use in

children< 3 years and for pregnant women

No latex in the gloves, needles, syringes used in these

clinics

No latex in Tdap or Pneumovax vaccines

Screening

3. Do you have a fever today?

If yes, do NOT give any vaccines

Refer to health care provider or

Provide the pt with information about regular

Public Health Immunization Clinics

Screening

4. Are you allergic to eggs?

If yes, what is the severity of the allergy?

Ask if they eat bakery items. If yes, then Flu

vaccine is ok.

Anaphylaxis is a contraindication for flu vaccine

Screening

5. Is there a history of Guillain-Barre syndrome

(a severe paralytic illness)?

If yes, do NOT give Flu vaccine

If yes, do NOT give Tdap

6. Do you have any of the following medical conditions or risk factors?

If the pt indicates yes by circling any

of the conditions listed below then they should not receive Flu LAIV (FluMist nasal); instead give injectable Flu vaccine

Asthma/wheezing

Anemia/ blood disorder

Heart ds, lung ds, kidney ds

Diabetes

HIV, cancer treatment

Long- term steroid use

Neurological problem

Daily aspirin use <18 yrs

These questions are also used to screen for indications for Pneumococcal (Pneumovax). If the following conditions are circled yes and the pt is 19 yrs and older, Pneumococcal vaccine may be indicated:

Smoker

Alcoholism

Cochlear implant

Lung disease

Blood disorder

HIV

Diabetes

Screening

7. Do you have close contact with a person who

is in a bone marrow transplant unit?

If yes, do NOT give Flu LAIV (FluMist nasal); Give

injectable Flu vaccine instead

Screening

8. Have you received any live vaccines in the last

month? MMR, Varicella, (chickenpox)

If yes, then do NOT give Flu LAIV (FluMist nasal);

instead give injectable Flu vaccine

Screening

9. Are you pregnant? If yes how many weeks?

If yes, give preservative-free, pre-filled syringe

dose of injectable Flu vaccine.

If 2nd or 3rd trimester, then offer Tdap if not

current

Pneumovax is contraindicated during pregnancy

Second Dose

• A second dose of flu vaccine is recommended

for some children between 6 mos through 8

years of age

• If the child did NOT receive any H1N1 vaccine,

they need a second dose of this year’s flu

vaccine one month later

• If this is the first year that a child is receiving

flu vaccine, they need a second dose of this

year’s flu vaccine one month later

Screening Recap

•Check the box next to the vaccine(s) to be given

•Provide Vaccine Information Statements for the

vaccines to be given

•Be prepared to answer questions or concerns pts or

parents may have regarding vaccines

Screening

• Questions?

Vaccination

• Verify patient’s identity and which vaccines they are receiving

• Prepare and administer the vaccines

• Fill out the form with the site where you gave each vaccine and sign/date the form – KEEP THIS FORM (put in Form Collection Box)

• Fill out the IZ Record for the patient indicating name, dob and which vaccines they got and give that to the patient

Vaccination

• All injectable vaccines will be

given with safety needles or

syringes

Vaccination

• Route - all injections are IM (intramuscular)

If you are uncomfortable administering a

vaccine to an infant, a clinic RN is available to

do this at all sites.

• Injection Site – either arm can be used.

Nurse-only Section of Form

Vaccination

• Must chart on the Nurse-only section of form:

– Lot number – most will be filled in

already

– Site (if injection)

– Nurse’s signature

Training Resources

• Eziz.org

• Video available from Erika Jenssen, 925-

313-6734

• Public Health Immunization Clinics – for

schedule see

http://cchealth.org/services/immunization

Vaccination

• Questions?

Thank you!

See you on November 10th!