1. Saturday, October 24 And Saturday, November 7 2009 Kaiser Permanente Seasonal Flu Clinics Copyright © 2008-2009. All rights reserved.

2. Kaiser Permanente Clinical Faculty Contact information Before the Flu Clinics: Phone: 303-636-2937 Email: mary.wolbach@kp.org Contact number During the Flu Clinics: Pager: 303-203-6046 Mary Wolbach RN, BSN

3. Thank You for participating Today, you are learning some Flu Clinic basics. Each medical office has some individual work flows. Please arrive on time for instruction and opportunity to administer Flu vaccine to your peers.

4. Course objectives Student Expectations for Flu Clinic Safety Glide Needle Sharps Safety Parameters of the Influenza Vaccine Flu Safety Recommendations Flu Documentation Requirements We will review: Relevant graphic

5. Uniform Students: School uniform Closed toe shoes School name tag visible Faculty: School Name tag visible and a lab coat over business dress or scrubs

6. Note Valuables should be on your person or locked in your vehicle trunk.

7. Note All medical office campuses are non smoking facilities.

8. What If ???? The faculty member is delayed or unable to come? Students may only participate with faculty on site.

9. Attaching the needle Only sterile for one hour afterwards Sterile technique

10. PLAY IT SAFE! _____________ If tired or feeling rushed SLOW DOWN! FLU SAFETY MESSAGE One handed safety activation only Use designated sharps containers Activate safety needle immediately after every injection Do not let sharps containers overflow

11. What If ??? There is a needle stick injury or blood exposure? Tell the patient what happened. Ask them to stay for lab work. Tell the faculty and staff. Your initial lab work will be drawn at Kaiser Permanente. Arrange through school for long term follow up.

12. Orders for Influenza Vaccine Injection Flu Vaccine for Adults There is a written standing order for influenza vaccine to be administered. Copies of standing orders will be available at the clinics.

13. Contraindications Patient has known allergy to to egg proteins (eggs or egg products) to chicken proteins or history of a serious reaction after previous administration of the vaccine Influenza vaccine should not be administered to individuals: who have a prior history of Guillain-Barré syndrome (GBS) who have had an allergy shot within the last 24 hours Vaccination may be postponed in case of febrile illness or acute disease. As with any vaccine, vaccination with influenza vaccine may not protect 100% of susceptible individuals.

14. Parameters for Influenza Vaccine Injection Vaccine should be administered according to the standing order: Adult 0.5 mL 1 dose Intramuscular In case of a serious reaction to immunization, notify Kaiser Permanente staff immediately

15. Note What if this is the patient’s first Flu Shot???

16. Landmark the Deltoid Site Positioning patient with arm relaxed at side. Locate the acromion process and head of humerus. Three finger widths below the acromion process Above the level of the axillia. In the center of the upper arm. This is where your injection site will be. 1 2 3 4 5 6 Intramuscular Injection 1 2 5 4 6 3 2

17. Technique Patient should relax arm with hand on hip. May be standing or seated. Cleanse identified site with a circular motion. With immunizations, aspiration is optional. Follow your school practice recommendations.

18. Different Flu Vaccines to be available in the clinic Students will administer one type of vaccine

19. 2009-2010 Influenza Vaccine Products Age IndicationNameManufacturerDosage 4 years and olderFluvirin®Novartis 0.5 mL intramuscular 6 month - 35 monthsFluzone®Sanofi 0.25 mL intramuscular 3 years (36 month - 47 months)Fluzone®Sanofi 0.5 mL intramuscular 2 years - 49 years FluMist® (LIVE VIRUS) Med-Immune0.2 mL given intranasally (The PREFFERED agent for children ages 2, 3 & 4 years) Options for Flu Vaccine Students assist with ADULT vaccine

20. Novartis (Fluvirin) Age Indication: 4 years through Adults Nursing students will only immunize adults (18 years and older) Dose 0.5 mL

21. (Fluvirin®) Dose 0.5 mL Given IM Age Indication: 4 years and older Pre-filled syringes from the manufacturer. A sterile needle must be attached using sterile technique. Vaccine must be used within one hour of attaching the needle, or it will expire. NOTE: All students are expected to perform the three checks and five rights.

22. Flu Safety Recommendations Remember safety is first and efficiency second. Take adequate time to be safe. Remember the Three Checks and Five Rights Nursing students and Faculty must confirm correct medication as follows:  On paperwork  On ALL vaccine syringes Nursing students will only immunize adults (18 and older)

23. Flu Documentation

24. Flu Clinic Documentation Step 1 Step 2 Step 3 Step 4 Use data collection form to document flu vaccine administered Verify Medical Record Number is on Form. Verify Patient’s Name and Age is on Form. Document the date, time and Lot # fields. Step 5 Step 6 Step 7 Select Novartis Fluvirin 0.5 ml Indicate the site of the injection. Confirm VIS sheet and after care instructions given. Sign with legible signature and make sure the documentation is complete. Step 8

25. Doe Jane 000-00-0000 x x x x xx Nancy Nurse, SN, School / Faculty Signature UA100654B 10-24-2009 09:00 68

26. Signature N. Nurse, SN-SON Legible Signature SPN or SN School of Nursing Co-signature by Faculty

27. Novartis Fluvirin® 0.5 mL Given IM 4 years and older Students will assist with the injection of this vaccine on all adults (18 years and older) Novartis Fluvirin® 0.5 mL Given IM 4 years and older Students will assist with the injection of this vaccine on all adults (18 years and older) Course summary

28. For your Reference: References Becton Dickinson, www.bd.comwww.bd.com Centers for Disease Control and Prevention Minimum Flu Safety Recommendations, Kaiser Permanente, 2009 Morbidity and Mortality Weekly Report, 2006, p. 19 Regional Standing Order Influenza for 2009-10, Kaiser Permanente