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Massachusetts Department Of Public Health Training Module

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1 Massachusetts Department Of Public Health Training Module
Planning a Clinic/EDS/POD In Response to Infectious Diseases, Emergencies, or Disasters Presented by: Katie Reilly, RN, BSN, MPH Infectious Disease Response Nurse Massachusetts Department of Public Health November 12, 2010

2 Learning Objectives Identify potential emergencies and emergency response List steps in planning and operating a clinic/EDS/POD Identify possible community assets and resources in response to public health threats Consider plans for internal and external communication

3 An All-Hazards Approach to Planning
Are We Prepared? Think Globally, Act Locally!

4 What Could We Be Facing? Bioterrorist Attack: Infectious Disease:
Anthrax, Plague… Infectious Disease: Influenza, SARS… Local Infectious Disease Response: Food Handler with Hepatitis A, Meningitis Case… Natural or Man-Made Disaster: Floods, Earthquakes, Nuclear events…

5 Local Response Timeline and scope of response depends on type of disease or incident Identify site(s) where the local community will receive vaccination/medication Staffing provided by local volunteers and professionals

6 “The Team”

7 Incident Command System (ICS)
Establishes Chain of Command Abbreviated version of ICS: Flexibility Scalability Span of control Most important thing to know: Direct Supervisor

8 Pre-clinic Planning CDC

9 Planning team considerations
Target population Required response Capacity Staff roles and job descriptions Timeline Location(s) and clinic flow Communication Security & safety issues Process of vaccinating/dispensing

10 Planning team considerations
Legal Issues: Jurisdiction Public health laws, regulations & standards Licensure regulations Liability protection Consent (minor & intellectually impaired) HIPAA & FERPA (privacy protection laws) CORI & SORI (criminal background check) Record retention requirements

11 Develop an Operations Plan
Identify leadership Identify space, location, dates, times of clinic Obtain authorization from federal/state/local public health authorities (as needed) Obtain signed standing orders (for vaccine or medication, and emergency) Order and arrange for delivery and appropriate storage of vaccine/medication and clinic supplies CDC

12 Develop an Operations Plan (cont.)
Identify staff/volunteers, assignments, job descriptions, necessary training and schedules Verify current credentials/licensure of staff (e.g. CPR) Obtain necessary paperwork/documentation/information Assign set up, breakdown, and clean up duties Determine client flow from arrival to departure

13 Develop an Operations Plan (cont.)
Capacity and estimated throughput Safety and security plans Accommodations for individuals requiring additional assistance Just In Time Training (JITT), briefing and debriefing of staff System to report problems and concerns Method for disposal of sharps/biohazards

14 Staffing your clinic Potential volunteer sources:
Medical Reserve Corps (MRC) Massachusetts System for the Advance Registration (MSAR) of Volunteer Health Professionals (VHP) Civic organizations and faith-based groups Schools, colleges/universities Retired professionals Citizen Emergency Response Teams (CERT) Visiting Nurse Association (VNA) Occupational Health Nurses (OHN) American Red Cross (ARC)

15 Workforce Protection Plan
Developed to protect staff and encourage participation Provides vaccine or prophylaxis to staff, responders, health care workers Implement prior to opening site to the public Use as opportunity to practice operations plan and modify as needed

16 Internal Communication Staff
When: prior to, during and after clinic Who: all professionals and volunteers How: face-to-face, , phones, walkie-talkies, social networking, HHAN What: plans, dates, times, locations, trainings, roles, schedules, supplies

17 Internal Communication Local Partners
When: prior to, during and after clinic Who: public health, police, fire, EMS, MRC, MSAR, hospitals, private providers, neighboring communities How: face-to-face, , phones, walkie-talkies, ham radio, social networking, HHAN What: times, locations, schedules, plans, trainings

18 Internal Communication State and Federal Agencies
When: prior to, during and after clinic Who: MDPH, MEMA, MSAR, FEMA, CDC How: , HHAN, websites, conference calls, webinars, webcasts, phones What: recommendations, guidance, resources, policies, procedures, timeline, capacity, surveillance reporting

19 External Communication Public
When: prior to, during and after clinic Who: general/target/special populations How: newspaper, radio, TV, signage, Emergency Broadcast System (EBS), reverse 911, local cable, PSA’s, Facebook, Twitter, blogs, websites, webcasts, webinars, interpreters, Connect - CTY What: rationale, recommendations, strategies, plans, education, times and clinic locations

20 Staffing Considerations
Target population Severity of threat Timeline/capacity involved Demographics/special populations Amount of vaccine/medication available Staff available and their competency level Screening process Possible new and related cases of disease or potential exposure identified in subsequent days Paperwork required (pre-populated)

21 Choosing Sites Readily available, not already committed
Well known location(s) Adequate & accessible facilities; consider: Floor space Parking (staff/public) Public transportation Climate controlled Refrigeration Lighting Restrooms Kitchen area Security (inside and outside) Landline/cell phone reception/internet access

22 Consider Scheduling Clinics with Other Events/Activities
Fairs Sports events Malls Health screenings Child safety events Community events Faith-based activities

23 Vaccine/Medication Management, Storage & Handling
Points for vaccine/medication manager to consider: Security Transportation Storage requirements Follow manufacturer’s/MDPH recommendations on management, storage, handling and transport of vaccine/medication Vaccine Unit:

24 4/1/2017 Standing Orders Use current standing orders that are reviewed and signed by a physician or medical director and have on-site (vaccine/medication specific & emergency orders) Orders should include: name of vaccine/medication, dose, route/method of administration and inclusion/exclusion criteria Model vaccine standing orders available at: 24 24

25 Designated Areas of Clinic*
Parking/drop off Entry Registration Screening Vaccination/dispensing Observation Emergency treatment Exit/collection of forms (optional) *Consider setting up in advance and combining areas and functions based upon staff, population, facility…. CDC


27 Suggested Supplies & Equipment
Tables, chairs, privacy screens Refrigerator, coolers, thermometers Office supplies and required forms Phones/walkie-talkies Paper towels, tissues, trash containers/bags Signage Refreshments for staff in a secure area

28 Suggested Vaccination/Medication Dispensing Stations Supplies
Vaccine/medication Cold packs w/plastic containers Needles (different sizes) Safety syringes Sharps/biohazard containers Latex free gloves Hand sanitizer Pill crusher Water/cups Medicine cups Teaspoons/bowls Alcohol wipes Gauze/bandages Adhesive tape Tissues/paper towels Table coverings Trash containers/bags Required forms/pens

29 Safety & Security Planning
Maintain a list of authorized staff for each clinic Establish staff sign-in/sign-out procedures, including identification (e.g. name tags, vests) Develop policies and identify locations to secure vaccine/medication and supplies Plan to flex staff to meet demand and avoid bottlenecks Consider availability of police, fire and EMS CDC

30 Crowd Control Planning
Designate personnel for crowd & traffic control to: Hand out forms Maintain order/diffuse tension Update crowd about wait times Answer questions and concerns Make accommodations for individuals in need of additional assistance May use ropes & signage to direct traffic flow Place Signage at a level where people can see CDC

31 Signage for: Clinic location
Important information/instruction for target populations One-way flow of traffic inside EDS Diverse populations (use universal & specific languages) as needed Designated clinic areas Entrances, exits, restrooms Inside and outside facility CDC

32 Clinic Set Up

33 Prior to Opening Clinic
Designate and set up areas and stations Transport and secure vaccine/medication Provide All-Staff Briefing and JITT Ensure signage is posted and placed correctly Vaccination/Medication provided to work force and their families

34 Staff Expectations: Wear appropriate attire
Arrive on time for scheduled shift Sign in-arrival time, name, address, etc. Sign out for breaks and at end of shift Have picture ID, name tag, or vest Receive job assignment/job action sheet Receive Direct Supervisor’s name Attend All-Staff Briefing and Just In Time Training (JITT) Set up stations CDC

35 Parking and Entry Area Drop off for mobility impaired
Provide escorts/assistance Parking instruction Relay information to clients about: Target population Vaccine/medication available Hours of operation Clinic flow Provide interpreters

36 Registration/Orientation Area
Distribute necessary forms, such as: Disease Fact Sheet Vaccination Information Statements (VIS) Medication information sheets Screening forms Billing information forms (if applicable) Consent forms (if applicable) Release of information forms (if applicable) Assist with form completion and answer questions as needed Consider posting forms online ahead of time, and/or distributing at libraries, city hall, fire station, etc

37 Screening Area Screen for contraindications or precautions to vaccine/medication Answer questions or refer to Direct Supervisor Protect confidentiality and privacy Ask only “need to know” information for safe administration of vaccine or medication

38 Clinical/Dispensing Area
Appropriate forms should be completed before entry into clinical/dispensing area Staff/signage will direct clients to appropriate station Administer vaccine/dispense medication Restrict access to this area in order to: Reduce noise and confusion Protect privacy and confidentiality Support safety and security plans

39 Vaccine/Medication Preparation, Administration and/or Dispensing
Points to consider: Policies and procedures Standing orders (signed) Staff competencies Vaccine/Medication Administration Emergency Response Medical Facility Manufacturers and formulations Necessary documentation Supplies

40 Clinical Documentation
Pre-populate forms if possible Must be accurate, legible, and complete Must be secured and retained Consider electronic documentation May provide vaccine/medication record to the client Provide VIS to client for immunizations

41 Required Documentation for Administration of Vaccine
Patient’s name Vaccine name, manufacturer, lot number, expiration date and dose number Publication date on VIS, date VIS was given Anatomical site, route and dose amount Date vaccine administered Vaccinator’s name, initials, signature, and credentials Clinic name, address and contact person Signed consent is not required except when a parent/guardian is not present

42 Vaccine Information Statement (VIS)
Conveys risks and benefits of vaccine Produced by CDC Required by federal law Vaccine specific Must use current edition and not altered Give before each dose of each vaccine Provide an opportunity to ask questions Available in multiple languages at:

43 Medication Documentation
Patient name Age, weight (children) Type of medication Manufacturer Lot number and expiration date Date the medication was administered/dispensed Dose and route Name and address of the clinic site and contact person Name, initials, signature, and credentials of dispenser

44 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

45 Observation Area Observe for 15-20 minutes after vaccination
Especially if first time receiving vaccine Monitor for signs and symptoms of adverse reactions Provide educational materials, entertainment and refreshments (as available)

46 4/1/2017 Expect The Unexpected Plan for emergencies with personnel, facilities and equipment/supplies Obtain signed and current Emergency Standing Orders from physician or medical director prior to clinic* *Model Emergency Standing Orders can be found at: 46 46

47 Emergencies Adverse reactions to vaccine/medication
Other medical emergencies Police/Security emergencies Fire emergencies

48 Emergency Response Onsite emergency responders (whenever possible)
Community resources (ex. fire, EMS, police, local hospital) Emergency medical equipment and supplies Phone availability, location and 911 access

49 Emergency Supplies BP cuff and stethoscope (child & adult, extra-large cuffs) Cell phone or access to an on-site phone 3x3 gauze pads Alcohol wipes Bandages Hand sanitizer Latex free vinyl gloves (small, medium, large & extra large) Flashlight & batteries Thermometer & probe covers Instant cold packs Cots, Blankets, Pillows Wrist watch with second hand

50 Emergency Supplies, continued….
Acetaminophen 325 mg tablets Ibuprofen 200mg tablets Diphenhydramine 25 mg tablets Diphenhydramine 50 mg injectable-(carpujet) Diphenhydramine elixir 12.5mg/5ml suspension 25mg/5ml Epipen & Epipen Jr. & Aqueous Epinephrine 1:1000 injectable 1mg/ml Syringes-3mL-1” 23g, 5/8” 25g, 1mL Ammonia inhalant Airways (large & small) Pocket masks with one way valve (adult & pediatric) Tongue depressors AED

51 Exit Area Collect forms (if applicable)
Answer questions and report concerns Complete exit survey (if applicable)

52 Exit Survey Consider surveying clients for relevant
information such as: How did you hear about the clinic? How did you get to the clinic? How long did you wait? What did you like? What didn’t you like? Where do you live? CDC

53 Post Clinic Paperwork Adhere to medical record retention rules for keeping administration records Compile billing information (if applicable) Complete MDPH Vaccine Aggregate Usage forms Complete VAERS forms, incident and medication error reports if indicated CDC

54 Post Clinic Ensure proper storage and handling of unused vaccine/medication Contact MDPH regarding unused and expired state-supplied vaccine/medication Return equipment and unused supplies Dispose of sharps and medical waste Hold staff debrief/hotwash at end of clinic, or schedule a debriefing for later date Ensure staff signs out CDC

55 Staff Debriefing What worked? What didn’t work? Clinic challenges
Planning priorities for future Future availability of resources Additional suggestions/comments CDC

56 Some Common Pitfalls in Planning
Assumption that everyone is on the same page Different terms and concepts across disciplines Too many spokespeople Lack of training Misinterpretation of roles

57 MDPH Contact Numbers MDPH Epidemiology/Immunization Program
4/1/2017 MDPH Contact Numbers MDPH Epidemiology/Immunization Program (24x7) MDPH Vaccine Unit 57 57

58 Seasonal Flu Vaccine Reimbursement
Commonwealth Medicine (part of UMASS Medical School) is working with public & private health plans to provide reimbursement for the administration of the seasonal influenza vaccine in the public setting. Complete one insurance form for each individual who receives a vaccination Have vaccine recipient, or parent/guardian sign and date the form Fill out info in the Clinic/Office Use section for providers and sign and date the form Submit forms via or regular mail Forms and more information available online at:

59 4/1/2017 Online Resources MDPH Guidelines for Compliance with Federal and State Vaccine Administration Requirements MDPH General Protocol for Vaccine Storage, Administration, Standing Orders,& Immunization Clinics, Sept 2009 MMWR: General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices (ACIP), December 2006 CDC Guidelines for Setting Up Vaccination Clinics World Health Organization 59 59

60 Online Resources Massachusetts Department of Public Health (MDPH)
4/1/2017 Online Resources Massachusetts Department of Public Health (MDPH) MDPH Immunization Program Immunization Action Coalition Centers for Disease Control and Prevention (CDC) Epidemiology and Prevention of Vaccine-Preventable Diseases, The Pink Book: Course Textbook (11th Edition), May 2009 Vaccine Administration Errors to the Institute for Safe Medication Practices Guide to Vaccine Contraindications and Precautions 60 60

61 Online Resources MassPro for Flu clinic locations Adverse Events to Vaccine Adverse Events Reporting System (VAERS) School Located Vaccination: Information for planners Massachusetts Division of Health Professions Licensure License Verification Site Sharps disposal companies from the Massachusetts Department of Environmental Protection

62 Online Resources Recommendations for Drawing-Up Vaccine and Other Documentations Requirements for Clinical Sessions or Large Clinics CDC Guidelines for Large-Scale Influenza Vaccination Clinic Planning Commonwealth of Massachusetts, Department of Public Health, Emergency Dispensing Site, Management and Operations A Guide to the Massachusetts Public Records Law MDPH: Holding a Vaccination Clinic

63 Please join us for the other training modules!
All-Staff Briefing & Just-In-Time Training: November 15th, 3:00-4:30 Vaccine Management, Storage and Handling: November 16th, 3:00-4:00 Vaccine and Medication Preparation and Administration: available online soon! 4/1/2017 63

64 4/1/2017 QUESTIONS?? Thank You ! 64 64

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