Immunization Team Training - PowerPoint Presentation

1. Immunization Team Training

2. Soncerae Yeager, Immunization CoordinatorOffice: 412-563-7826 Email: SYeager@american-healthcare.netCecile Usner, Wellness ServicesOffice: 412-563-7802 Email: CUsner@american-healthcare.net Liz KancheCell: 412-818-2328 Email: LHKanche@american-healthcare.netChristine Cusick, BillingOffice: 412-563-7084 Email: CCusick@american-healthcare.netMeet Our Team

3. Services Overview

4. Senior BuildingsCorporate SitesSchools Community and Politician Sponsored EventsPlaces of WorshipMeet our Clients

5. 2002 Began Flu Shots 2004 increased immunization offerings2008 Vaccines for Students ProgramPathways to SmartCare works in conjunction with: CDC – Center for Disease Control RecommendationsACIP – Advisory Committee on Immunization PracticesACHD – Allegheny County Health Department RecommendationsSWIC – Southwest Immunization CoalitionCHIC – Crawford Health Initiative CoalitionPathways to SmartCare works under the direction of Preferred Primary Care Physicians. Standing orders are provided by PPCPImmunization Services

6. Our immunization team administered 10,768 vaccines in 2019-2020 (+269 from 2018-19)We worked with 288+ organizations & completed 506 clinics in 2019Our clients gave a 95% approval rating for customer serviceReview of 2020-2021 Immunization Season

7. Working at Pathways Wellness

8. Nurses: Scrubs or Business Casual with Lab CoatAdmins: Business CasualAll attire worn to the clinic must meet professional standards & comply with our Health Dress Code & Appearance Policy, which can be found in our training manual. Dress Code

9. Professionalism TipsWe are in a health care settingGreet the client contact in a professional, friendly and helpful mannerBe on time and prepared and confident in your jobAll medical questions and concerns should be directed to the nurseDo not use your cell phone for personal use Keep internal conversations internal & handle issues before they escalateHIPAA – remember you are dealing with Protected Health Information and act accordingly

10. Opportunities and Scheduling

11. NursesImmunizationsCOVID-19 Rapid and PCR TestingBiometric ScreeningsTB TestsOn Call ServicesCOVID-19 Rapid and PCR TestingTemperature ScreeningsClinic AdministratorsAssist with immunization and screening clinicPositions Available

12. Independent Contractor AgreementW9Proof of ImmunizationClearancesAct 33, Act 34 and Act 73Individuals working with us for a time period of at least 6 months will be reimbursed for the cost of the renewal of their required clearances.Drivers LicenseSocial Security CardCar InsuranceProfessional License and Certificate of InsuranceCPRChild Abuse ReportingYou Call the Shots Training Modules for RNsRequired Credentialing

13. Nurse Team LeaderFor small events where nurse can handle the coordination of supplies and paperworkAdministrative Team LeaderNot a nurseHandles delivery of vaccine, supplies and paperwork to the clinic, completes paperwork and helps coordinate the flow of the eventNurseWork alongside the Team Leader and other nurses to administer vaccinations and complete a successful clinicOverview of Roles

14. Call Site Contact 2 – 3 weeks before a shift:Verify Clinic Date, Time, & Location and important details regarding parking & set upRemind client to look at the Online Clinic Kit for forms needed for their clinic The office will send out an Estimate Survey for the clients to complete to get estimates. If a client tells you their estimates, please email it to usOrder and Deliver Vaccines, Supplies and Paperwork to the Clinic.You will receive an order from the office, please respond quickly with any supplies needed for this clinic along with delivery/pick up availability Email Clinic Summary Sheet after clinic to office Return Clinic Packet to the office within three daysAdministrative or Nurse Team Leader

15. Always bring Nurse bag & RN binderDetermine if the patient meets health and age guidelines for the shot(s)Administer the shot(s), Discard needle and any item which touched patient into Sharps Container & never dig through a sharps container. Give patient the Vaccine Information Statement & Record of ImmunizationSign appropriate section of form where the Nurse is required Report number of all vaccine doses remaining to Team Lead at end of clinic to report on the Clinic Summary Sheet Do not Throw away any vaccine if there is an error. Role of the Nurse

16. Download the App onto your phoneLocation, Date, Time, Location Contact and Clinic details – including estimates for eventTimecardsUpon hire, you will get an email from Shiftboard instructing you to login & create your pin/password. If you do not receive an email confirmation regarding your request, please contact the office. If you have any problems and/or questions, please call Shiftboard 1.800.746.7531 (Pacific Time). They are extremely helpful.Shiftboard - Scheduling Software

17. Clinics are scheduled and staffed based on Availability, Location of Clinics & QualificationsTime of the Shift indicates when you are to be onsite at the client’s locationClinic end times in Shiftboard are estimates. We know there are times a clinic will run long or short. Please adjust the actual time worked on your time card.Some shifts will be preassigned (to accept or deny) and others will be available for pick upChoose “Shared Calendar” under Schedules to see all shiftsShift Considerations

18. If you have advanced notice and cannot work your assigned shift, please try to find a replacement. If unable, please let the office know within 48 hours.Emergencies that arise within 48 hour of your shift, call/text Liz or Soncerae. Do not email or leave a message on the office phone so that we may manage the client’s expectations. Shift Considerations - Continued

19. Creating a TimecardSign into Shiftboard. Click on TimecardClick on the + sign on the lower right sideYour name will populate in the Account lineAssigned shifts are automatically loaded into the Shift Line. Use the down arrow to select the shift you are entering onto your timecard.Hours will auto populate. Please check they are correct and make adjustments based on actual hours worked. Do not enter mileage, bonus, or event fee.Click Add Timecard at the bottom.Timecards should be entered on the day worked.Timecards will be processed the first day of the month, any missing timecards will not be paid on time.

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21. Mileage is calculated after 15 miles from your home and based on the current IRS reimbursement rate.Parking and toll fees are reimbursed monthly and recorded on the expense report. Please electronically submit all receipts with expense report.Expense report is available on the Internal Staff webpage.Payments in Addition to Shift Hours

22. Working an Immunization Clinic

23. Clinic Summary SheetRecord numbers of each vaccine that are in the Team Leader’s total inventory at the beginning of the clinic and the ending totals at the end of the clinic.Total # of shots givenAmount of payments receivedSign your name on the paperworkPatient Consent FormCompleted by each person receiving an immunization – checked by admin or RNTip: Use a highlighter to make sure all items are completed There must be an administration code for every vaccine givenNotification of Vaccination/Immunization CardsGive each Student & Senior a Notification of Vaccination form Give each Adult a Notification of Vaccination form or Immunization CardGive Vaccine Information Sheets (VIS) to all patients.Clinic Paperwork

24. Prompt Return NeededDateClinic Name – As stated in ShiftboardVaccine given by typeTotalNameIncludes:Consent forms Clinic summaryCopies of insurance cards – if they are providedTransact forms – for Medicare clients receiving Shingrix & TdapPayments – if they are provided (will be noted on Vaccine Reservation Form)Clinic Packet

25. Delivery of Supplies: You will receive a completed Supply Order Form each week for the next week’s clinics. Once you receive it, please complete the following and email to the office:List all Vaccines that are in your Refrigerator/Freezer – Your InventoryRequest any needed paperwork & suppliesDesignate if you will pick up supplies or are in need of a deliveryDelivery driver will be in touch with you to arrange deliveryKeep in mind: if you have multiple nurses you will need separate supplies for each of their stations (sharps containers, etc)Supply Delivery

26. Clean the space and leave no remnants of clinic supplies.Only paper wrappers that have not touched patient can be disposed of in the site’s waste basket; any supplies that have touched the patient must be disposed of in the Sharps Container by Nurse.Team Leader completes the clinic paperwork at the siteDouble check that all forms are complete with:legible writing, billing info & coding, & Patient/Nurse SignaturesEmail picture of Clinic Summary Sheet to the office once completedPaperwork must be in our office within 3 days of the clinic via Mail, Drop off, or Delivery Driver. (Do not combine multiple clinic sites in an envelope).Enter your timecard on Shiftboard.A Quality Satisfaction Survey is sent to the client following the event. Comments/suggestions about the clinic – Contact Liz Kanche – LHKanche@american-healthcare.netFollowing the Clinic

27. Packets should be returned to the office within 3 days for proper billing timelines.All surplus of vaccine should be returned to the office.Email the office to request a Delivery driver to pick up packets or vaccine surplus from you. To properly track your inventory a Vaccine Return Form will be completed upon return to the office.Vaccine Returns & Packet Pick Up

28. COVID

29. Upon Entry into facility/site: Staff are required to wear the minimum PPE of a Face Mask and GlovesOptional Items: Shoe Covers, Head Caps, GownIf you choose to wear a face shield or safety googles, they need cleaned after each shift. Once cleaned, it can be reused.PPE Protocol

30. Pathways takes the health and wellness of your employees, residents, and our team seriously. Our clinical nurse manager will continue to update the protocol as the Centers for Disease Control and the Department of Health release additional direction to medical teams. Personal Protection Equipment:  Both Nurses and Admins will wear a mask and gloves during the duration of the clinic. Face Shields, Gowns, and additional PPE are available upon staff’s request.  Immunization AreaCOVID-19 based regulations state that the immunization area should be wiped down every hour at a minimum. This may be increased at the discretion of the managing RN at the clinic.Keep room/s well-ventilated; open doors and windows to help with air circulation.COVID-19 Protocols: Client Information

31. Temperature ScreenedEach patient will have their temperature screened upon entry to the clinic and prior to receiving immunizations. Nurses or admins may screen temperature.  This may be waived if the patient had their temperature screened to enter the building or workforce. Anyone showing signs/symptoms of COVID-19 will not be able to get their vaccination/s. Social DistancingSocial distancing of 6 feet will be in place and if that cannot be maintained we will take your number and contact you when the space becomes available. Please display the sign that is in your bag.COVID-19 Protocols: Client Information

32. Review the Thermometer ProtocolProtocols are uploaded on Staff private websiteTest the thermometer upon arrival (allow the thermometer to warm up 15 minutes before arriving on-site if it’s been left in a cold climate)If the patient has an elevated temperature (100.4 F +), report them to their supervisor & record accordingly.Remember to sanitizer thermometer & replace it back into the box once finished or for the next user.Temperature Screenings

33. Please review the CDC’s PPE Protocol:https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdfDisposable of PPE

34. Insurance Review

35. We work diligently in the office to ensure that the immunizations requested are covered by the patient’s insurance BEFORE you even go into the field.This is done for 100% of corporate & school clients which make up 65% of our clinics.New in 2020 - We’re verifying all vaccines at senior living facilities prior to their clinic to help with this as well. At Community events – you may run into some unknowns. Please use the following info as a guide.Insurance Review

36. COMMERCIAL PLANSAetna will typically start with a “W”Meritain & Starmark (independent subsidiaries of Aetna)CignaHighmark Blue Cross Blue Shield – will typically have 3 alpha prefix (ie: YYM, YYR)HumanaTricareUnited HealthcareAll Savers (part of the Salvation ArmyUPMC- all numerical no alpha characters (11 digits)Allwell/PA Health & WellnessMEDICARE PLANS- Seniors or DisabledMedicare Advantage Plans is Primary Insurance & Medigap Blue is Secondary InsuranceAARP- Medicare Supplemental plans (insured by United Healthcare)Gateway Medicare AssuredHealth America AdvantraHealth America CoventryHighmark BC/BSFREEDOM BLUE- alpha characters SDRSECURITY BLUE- alpha characters: FEI, FEM, FER, HRF, HRT, USKHumana ChoiceMedicare- red, white, & blue cardRailroad- red, white , & blue cardUPMC for Life (Except Plan: HMO Premier RX)IN-Network Insurance

37. MedicareMedicare Part B covers the flu shot & must be billed as G0008 code for administration! SO – anyone who has a Medicare Card, a Medicare Advantage card or a Medigap (Supplemental) is covered.Medicare Part D covers:Shingles, TDAP, & Hepatitis A – BUT, are Subject to deductible & Patient must fill out Transact FormMedicare Part B covers ANY Pneumonia (must be billed as G0009 code for administration).Medicare Part B covers Hepatitis B(must be billed as G0010 code for administration)

38. UPMC Not in-Network

39. We also accept cash, check and credit card paymentsThe current retail rates are in your packet Receipts are available Cash –Verify AmountCheck –Payable to American HealthCare Group, LLC Credit Card – Complete the Credit Card SlipInvoice Company- Note on consent form to Invoice Company if instructed by Site Contact or noted on ShiftboardNon-Insurance Payments

40. 2020-2021 Immunization Review!

41. Nurses are required to complete the CDC web-based immunization training modules, “You Call the Shots”Influenza  Meningococcal Hepatitis BMMRPneumococcal Tetanus, Diphtheria, and Pertussis (Tdap)Understanding the Basics: General Best Practice Guidelines on Immunization Vaccine Administration Vaccines For Children (VFC) Vaccine Storage and Handling Varicella Zoster Covid – 19 Vaccine80% passing grade on a test at the conclusion of the module is required to earn a Certificate of Participation and free CE credits. Please email Certificates to complete your credentialing.Immunization Training Modules

42. Flulaval (Quadrivalent; preservative free – age 3+ yrs) Prefilled Syringe (PFS) Administered 8,792 in 2019-20 FLUAD HD (High Dose) – MUST be 65yrs old. Prefilled Syringe (PFS)Administered 183 in 2019-20Flucelvax (Quadrivalent; preservative and egg free; 18+ yrs) – upon request Only.Prefilled Syringe (PFS)Administered 661 in 2019-20Administered IntramuscularBulk of vaccines given (administered 9,636 in 2019-20)Seasonal Influenza

43. Shingrix by GSKIntramuscularComes in both prefilled syringes and 0.5 ml single dose vialsPrescreen before mixing the adjuvant & immunization2 doses needed; 2nd should be administered anytime between 2 and 6 months apart CDC is recommending at 50 – but not all insurance companies will cover. Check with billing to verify age restrictions and get preapprovalMedicare does not cover Shingrix. Therefore, most recipients will have a Co-Pay as their Medicare Advantage plan may also not cover it full. Please check their Vaccine Reservation Form for the amount due. We do inform the patient prior to the event if they will owe $.Shingrix – To Immunize against Shingles

44. Boostrix by GSKIntermuscularPrefilled SyringeOne Time VaccineWhooping Cough is a highly contagious respiratory infection and can be fatal to babies up to 12mos.We administered 177 in 2018 and 219 in 2019Tdap is routinely given again at age 11/12y, but if has never received then it is recommended to be given ASAP.Tdap booster is important for HealthCare Providers (HCP) & anyone having close contact with an infant.Pregnant Women should receive Tdap vaccine with each pregnancy to protect the fetus.Medicare recipients need to have exposure for this to be covered. Otherwise, they will have a Co-Pay Tdap: (Tetanus, Diphtheria, & Pertussis (Whooping Cough))

45. Prevnar (PCV13) IntramuscularPrefilled Syringe Adults are a single doseProtects against 13 of the most severe types of bacteria that cause pneumonia Administered 65 doses in 2018 & 62 doses in 2019Pneumovax (PPSV23)  IntramuscularSingle Dose VialAdults are a single doseProtects against an additional 23 types of pneumonia bacteria Administered 114 doses in 2018 & 57 doses in 2019The Center for Disease Control (CDC) recommends 2 pneumococcal vaccines for all adults 65 years or older and specific chronic conditions, COPD, asthma, smokers, CHD, and renal diseaseSeniors should receive a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.  If a senior has already received any doses of PPSV23, the dose of PCV13 should be given at least 1 year after receipt of the most recent PPSV23 dose.  If the resident has Medicare- these are covered.  Medicare Part B covers 100% of the cost for both pneumococcal vaccines when administered at least 1 year apart.Pneumonia: 2 Vaccines available

46. Twinrix by GSK – 3 Series (0, 1, 6 months) IntermuscularPrefilled Syringes Standard Twinrix dosing is 3 vaccine doses over a span of 6 months. (1st Shot, One month, Six month).Hepatitis combo A/B - for HCP and people in contact with blood/needles, chronic liver disease, & for people who travel frequentlyAdministered 11 in 2019Energix by GSK Hepatitis B – 3 Series (0, 1, 6 months)IntermuscularPrefilled Syringes Standard Energix Hep B dosing is 3 vaccine doses over a span of 6 months. (1st Shot, One month, Six month).We administered 157 in 2019Havrix by GSK Hepatitis A 2 Series (0, 6-12 months)IntermuscularPrefilled Syringes 2 doses given at least 6 months apartWe administered 27 in 2019Hepatitis

47. Menveo by GSK: Meningococcal “ACWY” IntramuscularSingle dose vial with its own adjuvantRecommend Booster every 5 years if at an increased riskAdministered 21 in 2018 & 16 in 2019Bexsero by GSK: Meningococcal “B”IntramuscularSingle dose vial or prefilled syringe 2nd dose given at least 1 month apartPatients must receive same vaccine product for all dosesRecommended for patients at prolonged increased risk every 2 -3 years. Administered 6 in 2018 & 15 in 2019Meningitis

48. MMR by Merck: Subcutaneous injection into the outer aspect of the upper armSingle dose vial with diluentLive VaccineFrozen Vaccine with refrigerated diluentCDC recommends that children receive two doses and adults should be up to dteAdministered 10 in 2018 & 50 in 2019MMR (Measles, Mumps, Rubella)

49. Varivax by MerckSubcutaneous injection into the outer aspect of the upper armSingle dose vial with diluentLive VaccineFrozen vaccine with refrigerated diluentTwo dose vaccine - A child should have the first shot at ages 12-18 months. The second shot should be given at ages 4-6 years. 3 Months between doses.Administered 8 in 2018 & 12 in 2019Varicella (Chicken Pox)

50. Gardisil 9 by MerckIntramuscularPrefilled syringe2 doses needed if given before 15th birthdayAges 9-15 (2 doses given 0, 6-12 months)Ages 15-36 (3 doses given 0, 2, 6 months)Not Required, but recommended for males and femail starting at age 11 or 12Administered 8 in 2019 Parent information meetings are availableHPV

51. Required VaccinesVarivaxTdapPolio (IPOL)MMR5 day exclusionCurrent requirements only allow students 5 days after the start of school to be fully immunized or risk being excluded from school.RequirementsA 4th dose of Polio for entrance into kindergartenTdap and Menveo for entry into 7th grade in the State of PA.Menveo for entrance into 12th grade in the State of PA.Gardasil 9 by Merck HPV (Human papillomavirus)2-3 Shot Series depending on age when it’s startedRecommended for both boys & girlsStress Cancer PreventionVaccines for Student Program

52. LIVE vaccines: FROZEN (and mixed with Diluent which is refrigerated)MMR Varivax (Varicella/chicken pox)INACTIVE vaccines: Shingles(Shingrix) Pneumovax 23 Prevnar 13FluHep A, Hep B, Twinrix(combo HepA & HepB)HPVTdapMeningitis ACYW & BNote: LIVE vaccines can be given simultaneously if given on the same day. If not, they should be given 28 days apart. That is so the ideal immune response will be given by the body to produce antibodies. LIVE & INACTIVE viruses can be given together and it does not effect the immune response if given less than 28 days apart. Live vs. Inactive Vaccines

53. Review Emergency Protocol- CALL 911See Standing OrdersEpinephrine is provided in an glass ampule 1:1000(1mg/1ml), with a filtered needle/1 cc luer lock syringe/ 1 – 1 ½ in. needle for injection.Note: Usual adult dose is 0.1 to 0.5mg (0.1 to 0.5ml of 1:1000 solution). May be repeated q 10 - 15 min as needed.Note: In pediatrics patients, administer 0.01 mg/kg or 0.3mg/ml to a max. of 0.5mg SQ. Do not exceed 0.5mg.Smelling saltProtocols for Emergency

54. If a syringe leaks when Flu Vaccine given, another dose of Flu vaccine should be given. MUST RECORD LOT # of Leaky Syringe.Document the doses given & lot #s. (always check syringe connection before giving injection).Document on the clinic summary sheet in Overage/Underage ColumnDo not throw away any vaccines - Call OfficeProtocol for Syringe Leaks

55. If a medication error should occur:Document the Vaccine, Site given, and Lot #.  Review patient’s history to be sure there are no contraindications for the medication given. Notify Liz immediately after the ClinicProtocol for Medication Errors

56. Can multiple LIVE vaccines be given simultaneously?Yes, they can be given simultaneously, however if not given simultaneously, there should be a 28-day minimum interval between LIVE vaccinations.Can LIVE and INACTIVATED vaccines be given simultaneously?Yes, they can be given simultaneously and at any interval between doses. Simultaneous administration of the most widely used live and inactivated vaccines does not result in decreased antibody responses or increased rates of adverse reactions.Commonly asked Questions

57. Centers For Disease Control and Prevention (CDC)cdc.orgAdvisory Committee on Immunization Practices (ACIP) acip.orgImmunization Action Coalition (IAC) immunize.orgAllegheny County Health Department (ACHD)achd.netAllegheny County Immunization Coalition (ACIC) immunizeallegheny.orgPathways to SmartCarepathwayswellnessprogram.comImmunization Information

58. We look forward to working with you!We will be holding weekly calls with our actively working staff.Please join us when your schedule permits!Thursday Trainings:   Register in advance for this meeting:https://us02web.zoom.us/meeting/register/tZYvc-qtrDwjGdO-zxpt45kHhdtFfoNa4siR   After registering, you will receive a confirmation email containing information about joining the meeting.