Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Are you ready for a Site Visit? Presented by: Beth Meadows, RN Wendy Holmes, RN Introduce self Presented by Beth Meadows, RN and Wendy Holmes, RN 1 1

Background on the North Carolina Immunization Program (NCIP) ??? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Background on the North Carolina Immunization Program (NCIP) ??? The North Carolina Immunization Program (NCIP) works in conjunction with the federal vaccine supply program, called the Vaccines for Children (VFC) program, to provide vaccines to health care providers across the state who administer childhood immunizations The NCIP and Vaccines for Children (VFC) Program provides vaccines to children whose parents or guardians may not be able to afford them Background NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 2 2

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Background Cont… NCIP helps to ensure that all children have a better chance of getting their recommended vaccinations on schedule NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 3

Which Vaccines are Available? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Which Vaccines are Available? ACIP Recommended CDC approved Vaccines available through the VFC Program are those recommended by the Advisory Committee on Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC). All vaccines listed on the childhood and adolescent schedules are included. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 4 4

Who is enrolled in the program? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Who is enrolled in the program? Health Departments Federally Qualified Health Clinics/Rural Health Centers Private Physician Offices School-based Health Clinics Hospitals Youth Detention Centers Review total # of providers and how much vaccine is typically distributed in a year. There are 1,279 providers that are part of our program. 100 Health Departments, 132 Federally Qualified Health Clinics/Rural Health Centers, 922 Private Physician Offices, 14 School-based Health Clinics, 69 Hospitals, 16 Job Corps/Youth Detention Centers, 26 Colleges/Universities NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 5 5

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? What is a Site Visit? ~ Formal quality assurance visit to enrolled providers. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 6 6

Site Visit Objectives: NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Objectives: Evaluate provider compliance with the NCIP and Vaccines for Children Program in both private and public healthcare settings Evaluate compliance with NC specific Immunization Laws and rules NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 7

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Provider Agreement READ and HEED!!!!! Site Visits are based off of the provider’s vaccine agreement. Refer to packet insert. While the lead physician signs this agreement, it is imperative that those involved in vaccine administration also read the agreement. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 8 8

Site Visit Objectives: NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Objectives: Evaluate provider compliance with the NCIP and Vaccines for Children Program in both private and public healthcare settings Evaluate compliance with NC specific Immunization Laws and rules NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 9

Provider Enrollment Who Should Sign the Provider Enrollment Form? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Provider Enrollment Who Should Sign the Provider Enrollment Form? Who Should Sign the VFC Provider Enrollment Form? Section 1928 (c) (1) (A) of the Social Security Act (42 U.S.C. 1396s (c) (1) (A) states that the following providers qualify to be VFC program-registered providers: those healthcare providers "licensed or otherwise authorized for administration of pediatric vaccines under the law of the State in which the administration occurs" (subject to section 333 (e) of the Public Health Service Act, which authorizes members of the Commissioned Corps to practice). The VFC statute follows state law in qualifying practitioners as VFC providers. The term “authorized for administration of pediatric vaccines” is intended to mean authorized to “prescribe” vaccines. Therefore, only providers authorized to prescribe vaccines under state law should be the official VFC program-registered providers. However, other providers authorized to administer vaccines can operate under the supervision of a prescribing VFC provider and should be listed on the Provider Enrollment Form. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 10 10

NC Prescribing Authority NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NC Prescribing Authority SECTION .1000 - PRESCRIBING 21 NCAC 32B .1001 AUTHORITY TO PRESCRIBE (a) A license to practice medicine issued under this Subchapter allows the physician to prescribe medications, including controlled substances, so long as the physician complies with all state and federal laws and regulations governing the writing and issuance of prescriptions. (b) A physician must possess a valid United States Drug Enforcement Administration ("DEA") registration in order for the physician to supervise any other health professional (physician assistant, nurse practitioner, clinical pharmacist practitioner) with prescriptive authority for controlled substances. The DEA registration of the supervising physician must include the same schedule(s) of controlled substances as the supervised health professional's DEA registration. History Note: Authority G.S. 90-2(a); Eff. June 1, 2007. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 11

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Provider Agreements Type of Agreements Local Health Department Agreement Private Provider Agreement NCIR Provider Agreement Non-NCIR Provider Agreement There are three types of provider agreements. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 12 12

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Coverage Criteria NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 13 13

Provider Level Compliance Site Visits NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Provider Level Compliance Site Visits How we pick provider sites to visit? How we pick provider sites to visit NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 14 14

Items needed for the site visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items needed for the site visit Include: Un-interrupted meeting time with the vaccine contact staff Past three months of vaccine temperature logs Access to vaccine storage units, temporary and permanent storage Access to the circuit breaker NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 15

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Needed, Cont. Vaccine Information Statements (VISs) Borrowing and Replacement Forms Disaster Recovery Plan NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 16

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Needed, Cont. Vaccine Information Statements (VISs) NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 17

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Needed, Cont. Borrowing and Replacement Forms NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 18

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Needed, Cont. Disaster Recovery Plan NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 19

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Who Conducts the Visit? Regional Immunization Nurses Regional Program Consultants Discuss the difference between the typical visit with a RIN and the storage visit by RICs. Refer to RIC/RIN handout NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 20 20

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Process Scheduling Letter/Questionnaire Once the visit is scheduled, the NCIP will fax/mail a letter confirming the visit. The letter will include which items to pull for the visit. The letter will also include a portion of the site visit questionnaire that you will need to complete prior to the visit. Please ensure you complete your question and fax it back to the nurse by the date indicated in the packet. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 21 21

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review The nurse consultant will review ten random charts in the NCIR prior to the visit to ensure vaccines are provided on time and simultaneously and to the correct patients (VFC eligible). Several reports from the NCIR will also be ran to review vaccine accountability. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 22 22

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 23 23

NCIR Review Vaccine Transaction Summary By Provider NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review Vaccine Transaction Summary By Provider NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 24 24

NCIR Review Vaccine Accountability Report NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review Vaccine Accountability Report NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 25 25

NCIR Review Vaccine Usage Report NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review Vaccine Usage Report NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 26 26

NCIR Review Wasted/Expired Vaccine Report NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIR Review Wasted/Expired Vaccine Report NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 27 27

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Non-NCIR User Vaccine Administered Log Borrowing Reports Wasted/Expired Forms NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 28 28

Day of the Visit- Assessment NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Day of the Visit- Assessment VIS’s/temps, etc. Storage units Circuit Breaker On the day of the site visit, the nurse will review all the items that were asked to be pulled, such as the temps logs, borrowing forms, disaster recovery plan, and VISs. The vaccine units will also be assessed for proper storage. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 29 29

Day of the Visit- Assessment NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Day of the Visit- Assessment VIS statements for all vaccines administered Past three months temperature logs for the refrigerator and freezer Access to all vaccine storage units, including those used for temporary storage Clear assess to circuit breaker NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 30 30

Day of the Visit, Feedback NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Day of the Visit, Feedback All findings will be reviewed with the vaccine contact Areas that need improvement will be discussed Education will be provided to improve vaccine services Follow up recommendations/requirements will be reviewed NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 31

Provider Improvement Plan NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Provider Improvement Plan Summary of out of compliance items will be provided Providers have thirty days to submit a corrective action plan to the NCIP NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 32 32

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Remember: We are EDUCATORS not AUDITORS Our goal is to help!!!!! NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 33 33

Common Site Visit Questions NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Common Site Visit Questions Our goal is to help!!!!! NCIP 2011 State Immunization Conference 34 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 34 34

Do I have to complete the site visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Do I have to complete the site visit? Yes!!!!!! Item #(17)Provider Agreement: Allow periodic VFC Site Visits or inspection of vaccine supplies and records as requested by the Immunization Branch Refer to provider agreement NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 35 35

How often are visits done? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? How often are visits done? Every other year (or more often as needed). NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 36

How Long Do the Visits Take? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? How Long Do the Visits Take? Approximately 1-3+ hours The length of the visits depend on many factors. NCIR visits are typically shorter. Providers who need more assistance and who have many questions will take longer. Keep in mind, the nurse will not need you to sit with her during the entire visit. She can review temp logs, VISs, etc. alone. NCIP 2011 State Immunization Conference Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 37 37

What are you looking for in my Fridge/Freezer? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? What are you looking for in my Fridge/Freezer? Staff are checking for proper storage of vaccine. In the next few slides we will review common storage errors. NCIP 2011 State Immunization Conference 38 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 38 38

Vaccine Storage Equipment NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Vaccine Storage Equipment This is an improper way to store vaccine. There are many reasons why this is unacceptable but the main reason is improper/poor air circulation. This provider will be required to purchase additional refrigerator space to allow air circulation. Problems with Household Combination For food/ beverage storage Temperature fluctuations Inadequate usable space This is an improper way to store vaccine. There are many reasons why this is unacceptable but the main reason is improper/poor air circulation. This provider will be required to purchase additional refrigerator space to allow air circulation. NCIP 2011 State Immunization Conference 39 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 39

Vaccine Storage Equipment NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Vaccine Storage Equipment Phase out interior freezer by 12/31/2009 (requirement) Any size unit with interior freezer Day storage only Temperatures 2 X daily Phase out units with interior freezers, regardless of size. This is effective December 31, 2009 (requirement) Dorm-style refrigerator/freezers are not designed or appropriate for storage of fragile and expensive vaccines All dorm-style refrigerators for permanent storage are to be phased-out of provider offices by December 31, 2009. A dorm-style refrigerator is a considered a combination refrigerator/freezer unit that is outfitted with one external door. As of December 31, 2009, dormitory-style refrigerators may only be used to store a clinic's single-day supply of refrigerated vaccines. Vaccines must be returned to the main refrigerator storage unit at the end of each clinic day. Temperatures must be monitored with a dedicated certified thermometer and documented twice a day on temperature logs specifically for that unit. NCIP 2011 State Immunization Conference 40 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 40

Vaccine Storage Practices NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Vaccine Storage Practices Diluents Water Bottles This is an ideal setting. Is it a reality? Probably not for most of you. It is our job to teach the best practice and work with you to help you ensure there is proper circulation, thermometers in all locations with vaccine, no vaccines in the door, vaccines stored away from the sides of the refrigerator and in the middle. Remember vaccines improperly stored will not protect your patient if it is inadvertently administered. Water Bottles Diluents NCIP 2011 State Immunization Conference 41 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 41 41

Vaccine Ordering and Inventory Management NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Vaccine Ordering and Inventory Management Label shelves/trays Mark multi-dose vials Date open Doses used Organize the refrigerator by attaching vaccine name labels directly to the shelves on which each vaccine type is positioned, or label trays or open-weave baskets according to the vaccines they contain. Mark multi-dose vials the date it was opened and use a slash mark to indicate doses used. This will help in tracking usage. NCIP 2011 State Immunization Conference 42 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 42

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Appropriate Refrigerator/Freezer Distinguish private/state Biological specimens Jugs of water – refrigerator Ice packs - freezer Certified calibrated thermometer (middle with vaccine) I am not going to individually review these items. The basis for this is a CDC Requirement and it is based on your Vaccine Agreement, NCIR Contracts, and the Minimum Storage and Handling Requirements. These slides are all part of your handout. The key is to review these slides and if you see anything out of place – correct it. NCIP 2011 State Immunization Conference 43 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 43

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Appropriate Refrigerator/Freezer No food Vaccine not in door Proper air circulation MMR in the freezer Properly rotate vaccine Do not pre-draw “DO NOT DISCONNECT” signs on the outlet and circuit breaker NCIP 2011 State Immunization Conference 44 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 44

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Temperatures log Checked and documented in a.m. & p.m. Temperatures maintained Written documentation of action taken NCIP 2011 State Immunization Conference 45 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 45

Why do you need to see our Vaccine Information Statements? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Why do you need to see our Vaccine Information Statements? Ensure you are using the appropriate VIS for each dose of vaccine you administer Ensure you provide a current VIS for each dose of vaccine given Review our providers responsibilities regarding the use of VIS’s Staff are checking to ensure VISs are the most current. We also assess whether or not providers are giving parents/patients copies at each encounter. NCIP 2011 State Immunization Conference 46 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 46

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? VIS FACT According to CDC, every time one of these vaccines is given — regardless of what combination vaccine it is given in — regardless of whether it is given by a public health clinic or a private provider — regardless of how the vaccine was purchased — and regardless of the age of the recipient — the appropriate VIS must be given out prior to the vaccination. NCIP 2011 State Immunization Conference 47 47 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 47

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? VIS FACT Use of the VIS is mandatory! Before a healthcare provider vaccinates a child or an adult with a dose of any vaccine containing diphtheria, tetanus, Pertussis, measles, mumps, rubella, polio, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), influenza, pneumococcal conjugate, meningococcal, rotavirus, human papillomavirus (HPV), or varicella (chickenpox) vaccine, the provider is required by the National Childhood Vaccine Injury Act (NCVIA) to provide a copy of the VIS to either the adult recipient or to the child’s parent/legal representative. NCIP 2011 State Immunization Conference 48 48 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 48

What else are you looking for? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? What else are you looking for? Vaccine Administration Practices Administration fee(s) to non-Medicaid VFC eligible patients Patient is unable to pay administration fee Office fee for an immunization only visit Prerequisite (i.e. physical exam) prior to an immunization only visit NCIP 2011 State Immunization Conference 49 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 49

Site Visit Requirements– Vaccine Schedule NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements– Vaccine Schedule Vaccine Schedule for children age 0 through 6 years: Dose 1 Dose 2 Dose 3 Dose 4 Booster Hep B schedule XXX DTaP schedule Hib schedule 3 dose Hib (i.e. Pedvax®) 4 dose Hib (i.e. ActHIB®, Pentacel®) IPV schedule MMR schedule Varicella schedule Hep A schedule Rotavirus schedule NCIP 2011 State Immunization Conference 50 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 50

Site Visit Requirements– Vaccine Schedule NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements– Vaccine Schedule Vaccine Schedule for children aged 7 through 18 years: Dose 1 Dose 2 Dose 3 Adolescent schedule for MCV4 XXX Adolescent schedule for Tdap Adolescent schedule for HPV NCIP 2011 State Immunization Conference 51 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 51

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Chart Review Documentation of VFC eligibility screening Provide all vaccines needed at every encounter Follow the recommended vaccine schedule/immunization rules/laws Document the relevant VIS publication date Documentation of the vaccine manufacture, lot number, site and route of administration Contraindications or precautions Copy/update lifetime immunization card/immunization record NCIP 2011 State Immunization Conference 52 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 52

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Vaccine Inventory Physical inventory 1X month Reconcile inventory weekly Record vaccine at time of administration and by no later than the COB daily Orders are appropriate based on enrollment data Rotate vaccines according to shortest expiration date Vaccines are clearly labeled Label public and private vaccines NCIP 2011 State Immunization Conference 53 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 53

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Chart Review (medical record) Name of vaccine given Date vaccine was given Date VIS was given Name of vaccine manufacturer Lot Number Name and title of person who gave the vaccine Address of clinic where vaccine was given Publication date of VIS Site noted in the patient’s medical record Route noted in the patient’s medical record NCIP 2011 State Immunization Conference 54 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 54

Site Visit Requirements NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Site Visit Requirements Other items Proper needle length for intramuscular injection VAERS forms/report adverse reactions NCIP 2011 State Immunization Conference 55 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 55

Items Most Often Out of Compliance at a Site Visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Most Often Out of Compliance at a Site Visit Incorrect administration fee charged to non-Medicaid VFC eligible patients Current Coverage Criteria not followed Misuse of state-supplied vaccine Inappropriately use Insured/Health Choice MMR, Td, Tdap for Adults Use DTaP instead of Tdap for Adults NCIP 2011 State Immunization Conference 56 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 56

Items Most Often Out of Compliance at a Site Visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Most Often Out of Compliance at a Site Visit Does not provide and or stock required and or recommend vaccines for VFC children (Medicaid, No Insurance, American Indian/Alaskan Native, Underinsured) NCIP 2011 State Immunization Conference 57 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 57

Items Most Often Out of Compliance at a Site Visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Most Often Out of Compliance at a Site Visit Does not follow required and or recommended schedule Does not follow immunization rules/laws Improper needle length for intramuscular injection NCIP 2011 State Immunization Conference 58 58 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 58

Items Most Often Out of Compliance at a Site Visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Most Often Out of Compliance at a Site Visit Vaccine Information Statements (VIS) VIS not up to date Publication date of VIS not recorded Medical Record Does not consistently record the date VIS was given Did not document signature and title of person who gave the vaccine Did not document publication date of VIS Did not document route NCIP 2011 State Immunization Conference 59 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 59

Items Most Often Out of Compliance at a Site Visit NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Items Most Often Out of Compliance at a Site Visit Vaccine Storage Written procedures for vaccine storage are not in place Temperatures out of range No action taken No written documentation of action taken Did not call the Immunization Branch for guidance A “Do Not Disconnect” sticker was not on the circuit breaker NCIP 2011 State Immunization Conference 60 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 60

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Always Remember: Follow your provider agreement and the law! NCIP 2011 State Immunization Conference 61 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 61 61

NCIP 2011 State Immunization Conference NCIP 2011 State Immunization Conference - Are you ready for a Site Visit? Questions???? NCIP 2011 State Immunization Conference 62 Presented by Beth Meadows, RN and Wendy Holmes, RN Presented by Beth Meadows, RN and Wendy Holmes, RN 62 62