Panorama Bulletin 0024 WHERE DO I DOCUMENT IN PANORAMA? Revised Sept. 2017 1 Immunization providers will use the features in Panorama to document immunization-relevant details (such as the Immunizations - Special Considerations function). A standardized approach to the documentation of these details should prevent extraneous clinical notes, prevent redundancy of information, protect sensitive information, enhance client privacy, & provide timely access to pertinent immunization information. Remember to check Bulletins, Policies, & the User Guides for more information or consult your Super User or supervisor if you still have questions after reviewing this reference. Bulletin 0022 has information about publicly funded vaccine eligibility & risk factors used in Panorama. Topics Scenarios Consent Directive Risk Factor Document Client Warning Deferral Reason Immunization Details Special Considerations Type Reason Source Refusals 1. Refusal of individual antigen(s) or vaccine agent(s) Refusal Exemption – Enter an ‘end date’ for refused vaccines to ensure the forecaster & reminder/recall remain functional for the next routine immunization age/grade (or to accommodate parental request if appropriate) To prevent reminder/recall from including those who have current valid refusal Verbal Refusals 2. Refusal of all vaccine agents Refusal See Documentation of Immunization Refusal policy if client requests no future reminders. The exemption directives in #1 may be applied as clients are to be informed that all students are offered vaccines in Grades 6 and 8 if a current antigen refusal does not exis. Refusals 3. Refusal migrated from SIMS as a Special Consideration> Exemption> Refusal End date the Client Warning but only if warning applies to this particular vaccine. If a duplicate special consideration exists, refer to revised bulletin 0027. Exemption - End date if conversation with client has occurred & the client is now accepting. If this is a second refusal (e.g. HPV in Gr. 8) then do not end-date or update the date field & enter a comment in the pre- existing exemption If adding end date then document reason as “No longer applicable” Verbal Refusals 4. Client now accepting a previously refused vaccine Grant Exemption - End date if conversation with client has occurred No longer applicable Documen tation, Verbal Eligibility by Risk Factor Category 5. Child eligible for early HB based on parental immigration Special Population - Children of Immigrants - Hepatitis B
Transcript
Panorama Bulletin 0024 WHERE DO I DOCUMENT IN PANORAMA? Revised Sept. 2017
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Immunization providers will use the features in Panorama to document immunization-relevant details (such as the Immunizations - Special Considerations function). A standardized approach to the documentation of these details should prevent extraneous clinical notes, prevent redundancy of information, protect sensitive information, enhance
client privacy, & provide timely access to pertinent immunization information. Remember to check Bulletins, Policies, & the User Guides for more information or consult your Super User or supervisor if you still have questions after reviewing this reference. Bulletin 0022 has information about publicly funded vaccine eligibility & risk factors used in Panorama.
Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Refusals 1. Refusal of individual antigen(s) or vaccine agent(s)
Refusal Exemption – Enter an ‘end date’ for refused vaccines to ensure the forecaster & reminder/recall remain functional for the next routine immunization age/grade (or to accommodate parental request if appropriate)
To prevent reminder/recall from including those who have current valid refusal
Verbal
Refusals 2. Refusal of all vaccine agents
Refusal See Documentation of Immunization Refusal policy if client requests no future reminders. The exemption directives in #1 may be applied as clients are to be informed that all students are offered vaccines in Grades 6 and 8 if a current antigen refusal does not exis.
Refusals 3. Refusal migrated from SIMS as a Special Consideration> Exemption> Refusal
End date the Client Warning but only if warning applies to this particular vaccine. If a duplicate special consideration exists, refer to revised bulletin 0027.
Exemption - End date if conversation with client has occurred & the client is now accepting. If this is a second refusal (e.g. HPV in Gr. 8) then do not end-date or update the date field & enter a comment in the pre-existing exemption
If adding end date then document reason as “No longer applicable”
Verbal
Refusals 4. Client now accepting a previously refused vaccine
Grant Exemption - End date if conversation with client has occurred
No longer applicable
Documentation, Verbal
Eligibility by Risk Factor Category
5. Child eligible for early HB based on parental immigration
Special Population - Children of Immigrants - Hepatitis B
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Eligibility by Risk Factor Category
6. Infant HB post-exposure prophylaxis in hospital
Post-exposure - Infant Born to HBsAg+ Mom or High Risk for HB - Greater than or equal to 2000 grams OR Post-exposure - Infant Born to HBsAg+ Mom or High Risk for HB - Less than 2000 grams
Only for infants who received HBIg: "It is recommended that these infants be tested for HBsAg and anti-HBs when they are at least 9 months old, and at least 1 month but no more than 4 months after their HB series is complete (CIG)."
Eligibility by Risk Factor Category
7. Tdap given to expectant mother/ parent/ caregiver of a newborn < 5 yrs from last Td
Special Population - Parents/Caregivers of Newborns
Eligibility by Risk Factor Category
8. People born since 1982-01-01 who live in Keewatin Yatthé, Athabasca or Mamawetan Churchill River health authorities or on reserves in Saskatchewan (excluding Creighton, Air Ronge & La Ronge)
Special Population – Hepatitis A Program – Targeted Community
Eligibility by Risk Factor Category
9. Household/sexual contacts of individuals who use illicit drugs
Special Population – Potential Exposure – Hepatitis A
Eligibility by Risk Factor Category
10. Household/sexual/ close contacts of an individual with acute or chronic HB
Contact – Hepatitis B “Post- vaccination testing for HB antibody is recommended 1 to 6 months after series complete.”
Eligibility by Risk Factor Category
11. Sexual partners & household contacts of individuals who use illicit drugs
Special Population – Potential Exposure – Hepatitis B
Eligibility by Risk Factor Category
12. Client with multiple sexual partners
Special Population – Potential Exposure – Hepatitis B
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Eligibility by Risk Factor Category
13. Percutaneous or mucosal exposure (sexual assault, bite, etc.)
Post-exposure – Blood & body fluids. The Forecaster is not currently engaged for HB for this risk factor but will validate & forecast once a series has been initiated).
“Post- vaccination testing for HB antibody is recommended 1 to 6 months after series complete.” If vaccine series is not initiated at initial contact a Client Warning could be added: “Client is eligible for HB vaccine.”
Eligibility by Risk Factor Category
14. Woman of childbearing age with non-immune varicella serology
Special Population – Varicella – non-immune woman childbearing age
Eligibility by Risk Factor Category
15. Student attending or accepted into a post-secondary health care program
Occupation - Health Care - Student
Eligibility by Risk Factor Category
16. Employee of RHA/SCA or FNJ
Occupation - Health Care - RHA/SCA/FNJ Employee
Eligibility by Risk Factor Category
17. Employee of a private care home or a private practice (dentists, physio, private nursing service)
Occupation - Health Care - Non-RHA Employee
Eligibility by Risk Factor Category
18. Male born since Jan. 1/06 who has an immune compromised condition other than HIV+
As applicable At this time, the 3-dose HPV series only forecasts for HIV+ RF, so add a warning that he is to get a 3-dose series, not a 2-dose series.
Vaccine not administered
19. Parent/client doesn’t want all recommended vaccines given on same day
Sample warning: “On DATE, parent/client requested that only vaccines A & B be given at visit.”
Parent/ Guardian/ Client Deferral
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Vaccine not administered
20. Nurse couldn't safely administer all vaccines the client is eligible for today
Choose as applicable: 1. Inadequate
muscle mass for imms; OR
2. Nursing Clinical Decision
Vaccine not administered
21. Child/client resistant to immunization
Parent/ Guardian/ Client Deferral
Vaccine not administered
22. Too ill to receive vaccine today
Serious illness - temporary
Vaccine not administered
23. Nurse to consult MHO before administration of vaccine
Add MHO’s recommendations.
Referred to MHO
Vaccine not administered
24. Vaccine unavailable
Vaccine Supply Issues
Vaccine not administered
25. Client late Insufficient appointment time.
Vaccine not administered
26. Client had to leave before vaccine could be given
Insufficient appointment time
Vaccine not administered
27. Client unable to wait 15 mins
Insufficient appointment time
Vaccine not administered
28. Panorama or local IT down
IT disruption
Vaccine not administered
29. Eligible for vaccine but waiting for serological results
Awaiting serology
Vaccine not administered
30. Live vaccine(s) forecasting but client stated they recently received a live vaccine that was not recorded into client’s record
Recent administration of live virus vaccine
Vaccine not administered
31. Client presents; unable to proceed until translation complete
Awaiting imms record translation
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Vaccine not administered
32. Immunization record has been requested for client prior to immunization
Awaiting imms record
Varicella Disease
33. Verbal report of varicella disease for client born since January 1, 2003 &/or who is in grade 6 & has a “Special Consideration – Precaution” migrated from SIMS
Offer Vaccine: Grant OR Refusal
Delete the Client Warning if pertains solely to varicella OR Update if pertains to more than one antigen by deleting varicella related information from the “message” box. Select “Other health care provider reported no longer applicable” as Reason.
Add “Effective To” date to end this “Special Consideration – Precaution”
Varicella Disease
34. Verbal report of varicella disease for client born before January 1, 2003 with a “Special Consideration – Precaution” migrated from SIMS
Delete the Client Warning if pertains solely to varicella OR update if pertains to more than one antigen by deleting varicella related information from the “message” box. Select “Other health care provider reported no longer applicable” as the reason.
Delete the “Special Consideration – Precaution” & enter Exemption as indicated below.
Exemption Documented Immunity
Verbal
Note: “Effective From” date defaults to today’s date. Update with the most appropriate date (e.g. from warning, lab result, record) only if services planned or presents for service. If client requests to be immunized in the future: Requires serology to confirm immunity status Document as follows:
o Immune - update the “Special Consideration-Exemption” response to Lab Report.
o Non-immune - add “Effective To” date to end this “Special Consideration – Exemption ”
Varicella Disease
35. Laboratory confirmed case of varicella disease
Delete Client Warning indicating there is a SIMS titre in Imms History Interpretation.
Exemption Documented Immunity
Documentation
History of Disease - Other
36. Serological evidence of measles, mumps, rubella, HA, or HB immunity
Exemption Documented Immunity
Documentation
History of Disease - Other
37. Client with chronic HB infection or immunity due to natural infection
Chronic Medical Condition - Liver Disease – Hepatitis B
Exemption Documented Immunity
Documentation, Verbal
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
History of Disease - Other
38. Client with HIV Immuno-compromised – HIV
"DO NOT GIVE ANY LIVE VACCINE(S) until consulting with a specialist or attending physician {phone #} & reviewing the specific immunization schedule”.
Contraindication Severely immunocomprised. Document for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG
Documentation, Verbal
History of Disease - Other
39. Client with laboratory confirmed HC infection
Chronic Medical Condition - Liver Disease – Hepatitis C
Documentation
Medical Conditions
40. Infant born to mother with HIV infection
"DO NOT GIVE ANY LIVE VACCINES. Call (PHONE NUMBER) to review the specific immunization schedule for this individual.”
Contraindication Suspicious family or medical history for immunodeficiency disorders. Document for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG
Documentation, Verbal
Medical Conditions
41. Authorization from ID Specialist or Positive Living Program to proceed with Rot-1 for infant (preliminary test from NML is neg.)
“Authorization to proceed with Rot-1 received on {date}”. PHN end-dates Warning once both doses Rot-1 have been given.
End-date Special Consideration - Contraindication pertaining to Rot-1 by adding an “Effective To” date
Medical Conditions
42. Authorization from ID Specialist or Positive Living Program to proceed with live vaccines for infant (e.g., two negative tests from NML)
Add “Effective To” date (using today’s date) to end date the warning from #39 above. Select reason as “Retesting shows no longer applicable”
End-date Special Consideration - Contraindication pertaining to all live vaccines by adding an “Effective To” date.
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Medical Conditions
43. Person with a Primary Immunodeficiency disorder (as noted in CIG)
"DO NOT GIVE ANY LIVE VACCINES. Call (PHONE NUMBER) to review the specific immunization schedule for this individual.”
Contraindication Suspicious family or medical history for immunodeficiency disorders. Document for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG
Documentation, Verbal
Medical Conditions
44. Immuno-compromised–Due to Treatment
Immuno-compromised - Treatment –Specify
NOTE: Depending on the client’s treatment-specific details either a Contraindication &/or a Precaution may apply to specified vaccines.
Contraindication ←See NOTE
Severely immuno-comprised. Comment section may be used for charting. Document for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG
Documentation, Verbal
Precaution ←See NOTE
Immunosuppressed - risk assessment required. Comment section may be used for charting.
Documentation, Verbal
Medical Conditions
45. Immuno-compromised - Related to Disease
Immuno-compromised - Related to Disease
NOTE: Depending on the client’s disease-specific details either a Contraindication &/or a Precaution may apply to specified vaccines.
Contraindication ←See NOTE
Severely immunocomprised Comment section could be used for charting. Document for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG
Documentation, Verbal
Precaution ←See NOTE
Immuno-suppressed - risk assessment required. Comment section could be used for charting.
Documentation, Verbal
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Medical Conditions
46. Blank forecasting for the following immunocompromised clients: Transplant Candidate or Recipient of Solid Organ/Tissue; Islet Cell or HSCT
Enter applicable Risk Factor (e.g. Immunocompromised - Transplant Candidate or Recipient - Islet Cell, etc.)
"DO NOT GIVE ANY VACCINE(S) Call (PHONE NUMBER) to review the specific immunization schedule for this individual (BLANK FORECASTING rule in effect)."
47. Client has received a blood product that cannot be documented in Panorama (e.g., packed cells, WinRho® SDF)
Note: At this time, Panorama does not identify interaction rules for immune globulin products & live vaccines
Contraindication
Recent Administration of a Blood Product (document for measles, mumps, rubella and varicella- containing vaccines) Add “Effective From” & “Effective To” dates (refer to SIM Chapter 5)
Documentation, Verbal
Medical Conditions
48. Client has received an immune globulin product
Enter any applicable Risk Factor (e.g. Post-Exposure - Rabies, Post-Exposure -Tetanus-prone Wound – TIg Needed, etc.)
Note: At this time, Panorama does not identify interaction rules for immune globulin products & live vaccines.
Contraindication Recent Administration of a Blood Product (document for measles, mumps, rubella and varicella- containing vaccines). Add “Effective From” & “Effective To” dates (SIM Ch.5)
Documentation, Verbal
Medical Conditions
49. Client has haemophilia
Chronic Medical Condition - Bleeding Disorders
“Severe Bleeding Disorder”
Medical Conditions
50. Infant’s mother took monoclonal antibodies during pregnancy
Immuno-compromised - Treatment –Specify.
Contraindication Set to end after 8 months of age.
Severely immunocomprised (Document Rota)
Documentation, Verbal
Other Circumstances
51. MHO client pre- or post-immunization consult
Document pertinent details
Document as applicable Document as applicable
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Other Circumstances
52. Infant receives measles-containing vaccine prior to first birthday due to travel to high risk area or due to potential exposure
As applicable: •Travel – Publicly Funded •Contact - Measles
Other Circumstances
53. Because of an individual’s DoB, Men-C-ACYW-135 forecasts for an individual who was immunized with Men-C-C with their Grade 6 peers
“Men-C-ACYW-135 is forecasting based of client’s date of birth, and they were immunized for meningococcal disease appropriately in Grade 6”.
Other Circumstances
54. Confirmed latex allergy
“Latex allergy”
Other Circumstances
55. History of fainting Note: Choose 1 of the vaccines given on day of event to document the SC, “Event occurred when vaccines administered {date}. (All vaccines given on this date do not need to be specified because this will result in several client warnings instead of the 1 warning that is actually required).
Precaution ←See NOTE
History of Syncope
Other Circumstances
56. Allergy to a vaccine component (i.e., eggs, thimerosal, etc.)
Precaution Allergy to a Vaccine Component – Document specific details in “Comments” field
Documentation, Verbal
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Other Circumstances
57. Student who gave mature minor consent for immunization is concerned that their parent will see their immunization history.
“Immunization profile is not to be sent to the student’s home in grade 8”.
Other Circumstances
58. Whole cell pertussis (wp or wP) containing vaccine in client’s history (e.g., DTwP-HB-Hib).
“DTwP-HB-Hib antigens are not counted in the Antigen Count, but are valid doses; ignore the forecaster & provide appropriate number of doses of these antigens”.
AEFIs 59. Mild to moderate vaccine side effects that do not meet the reportable AEFI criteria
Update (e.g.): “Redness & swelling at injection site 5 cm diameter but not extending past next joint. Resolved within 48 hours."
AEFIs 60. AEFI submitted by PH or non-PH provider for non-reportable criteria.
“AEFI report submitted for imms given on XXX, see imms details. Submitted for MHO review”.
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
AEFIs 61. Mild to moderate vaccine side effects that do not meet reportable AEFI criteria but PHN assesses she needs to alert next PHN to immunization details
(E.g.): "See comments for DTaP-IPV-Hib on December 12, 2014“ Expire this warning after next immunization received & update comments as required.
(for all applicable vaccines) - Update (e.g.): “Redness & swelling at injection site measuring 5 cm diameter but not extending past next joint. Resolved within 48 hours. Reaction appears to be more severe with each subsequent vaccine."
AEFIs 62. Severe, unusual, or unexpected vaccine side effect that meets reportable AEFI criteria & AEFI submitted.
"Reportable AEFI for immunizations administered on this date XX-XX-XXXX. See Imms Details. Submitted for MHO review.” Refer to Bulletin 0028 for additional information regarding documentation.
Document (for all applicable vaccines) - Update (e.g.): "AEFI meets reportable criteria - paper report dated XX-XX-XXXX. Provide details of AEFI.”
AEFIs 63. MHO/MD recommendation for non-AEFI issues
(E.g.)"See comments for (vaccine name) on XX-XX-XXXX." This warning could be end-dated after next immunization received. Update comment field as required.
Document (e.g.): "6 cm swelling at injection site but does not extend past joint. MHO recommends Benadryl prior to next immunization"
Unusual Events 64. Vaccine given when special consideration exists
Report form completed. See Comments for vaccine given _____date_____”.
Note if SC was undocumented at time of immunization. Detail in the Comments section of the indicated vaccine, including if was a provider error
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Topics Scenarios Consent Directive
Risk Factor Document Client
Warning Deferral Reason
Immunization Details
Special Considerations
Type Reason Source
Unusual Events 65. Vaccine prepared with expired diluent was administered.
Report form completed. See Comments for vaccine given _____date_____”.
Invalidate this dose. Detail in the Comments section of the indicated vaccine, including if was a provider error
Unusual Events 66. Vaccine leaked upon administration & a second dose was administered
Report form completed.
Document for the 1
st dose,
"Mechanical malfunction while administering dose. Dose to be repeated. Then invalidate 1
st dose.
Document the second dose and ensure that is valid.
Unusual Events 67. Vaccine administered by wrong route
Report form completed.
Update: "Vaccine given SC instead of IM. Clinical recommendation to repeat dose the same day or re-schedule according to min. interval rules.
Unusual Events 68. Dose administered before minimum age or interval
70. Parent indicates child (birth to grade 12) is up-to-date with immunizations but has no documentation. Vaccine series offered. Parent consents to booster doses only.
Grant "No documentation of historical vaccines available. Parent reports vaccines up-to-date for age." Never to be end-dated. Vaccines will continue to forecast as due until a complete series for age has been administered. Refer to #1 or #2 if appropriate. Do not override any dose numbers for a child with an undocumented immunization history.
71. Parent indicates child is up-to-date with immunizations but has no written documentation.
Vaccines offered but parent refuses.
Refusal “No written documentation of historical vaccines available. Parent reports vaccines up-to-date for age.” Vaccines will continue forecast as due until a complete series for age has been administered. Do not override the dose number for a child with an undocumented immunization history.
73. Td- Revised Dose: Canadian-born adult with no written documentation of immunization history but recalls having had childhood-/school immunizations based on DoB (refer to SIM)
“Client reports received all childhood/school vaccines but no written documentation available”.
74. Canadian-born adult with no written documentation of immunization history but recalls having had all childhood-/school immunizations based on DoB (refer to SIM)
“Client reports received all childhood/school vaccines but no written documentation available”.
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Topic Scenarios
Consent Directive
Client Warnings Deferrals Immunization
Details Communications Log Mass Imms
Grant or Refusal Warning Deferral Reason
Comments Topic Comments Client Event Status
Prov. School Imms Strategy Refer to Panorama Mass Imms User Guide for more details.
75. Consent not
returned by
targeted Grade
student
Consent Identify direction; identify communication type as applicable; topic is consent attempt
For targeted Grade student
If second attempt to obtain consent, update Event Status to: Consent Attempt 2
If third attempt to obtain consent Update Event Status to: Consent Attempt 3
76. Consent not
returned by
non-targeted
Grade student
Consent Identify direction; identify communication type; topic is consent attempt
77. Student absent
at school for
immunization
Absent For non- targeted Grade student – Identify direction; communication type is in-person; topic is absent
For targeted Grade student - Update MI Event Status to: Absent for Immunization (You can only do this once per worksheet so the second and subsequent absences would be with the communication log).
78. Contact
attempt for
immunization
(person of any
age)
Contact attempt
Identify direction; identify communication type as applicable; topic is contact attempt
79. Consent grant
but student
moves prior to
immunized at
school
Ensure the Consent
Given By field includes
the parent or guardian
name, and Consent
Given To include the
RN’s name.
For targeted Grade student - Update MI Event Status to: Moved out of School
80. Parent wants
student
immunized at
health centre
For non- targeted Grade student –Document “Will attend health centre for school-age vaccines”
For targeted Grade student - Update MI Event Status to: To Be Seen at PHO
81. Consent granted; but waiting for client imms record
Awaiting imms record
For targeted Grade student - Update MI Event Status to: Immunization deferred NOTE: This deferral will not reflect on the client’s Panorama record, thus a deferral must ALSO be created in the client’s Panorama Immunization record.
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82. Consent grant erroneously documented by nurse
Expire grant by placing client in context from the worksheet; then go to consent directive, add effective to date, and write ‘consent was granted in error’ in comments and save.
