Public Health Flu Clinic
Staff Orientation
November 1, 2010
Webinar Objectives
• Describe purpose and goals for November 10th
vaccination clinics
• Explain clinic operations:
– clinic layout: stations, client flow, staff positions
• Review staffing: Incident Command System (ICS)
– Roles, reporting structure, job action sheets (JAS)
• Provide staff instructions
• Answer questions
Clinic Purpose
• To provide free vaccines to Contra Costa County
community members to prevent disease
• To train Public Health staff to work at a mass
vaccination
Point of Dispensing
(POD)
Clinic Purpose Cont’d
• Our flu clinic PODs will be held at non-traditional
clinic sites, e.g., church, conference center,
library, school, etc.
Goals
• To vaccinate 9,000 community members in
one day at nine walk-through POD locations
throughout the county
• To help Public Health staff gain skills in mass
clinic POD operations
• To assist Public Health staff understand the
Incident Command System (ICS)
Flu Clinics• 9, free, walk-through POD sites, open to the public
1 pm to 7pm on Wednesday, Nov 10, 2010
Flu Clinics cont’d
• Clinics will offer free flu vaccine (shots or
nasal spray) to everyone age 6 months and
older
• Clinics will also offer free Tdap (tetanus,
diphtheria and pertussis/whooping cough)
and pneumococcal vaccine to those who are
eligible, while supplies last
Flu Clinics cont’d
• All are welcome
• Do not need to be a Contra Costa resident
(although we will ask for address)
• We have plenty of flu vaccine; we will shift
supplies around as needed
• FREE for everyone!
Staff Instructions
• You should have received a packet (email or
hard copy) with your reporting location and
role assignment (Job Action Sheet)
• Please read the information before arriving
• If unfamiliar with your
reporting location,
please map your route
to the site in advance
Staff Instructions Cont’d
• Site specific maps can be found at:
http://cchealth.org/topics/flu/vaccination.php
Staff Instructions Cont’d
• Please be on time! You should report to your
assigned location at the specified time
• If you cannot report to the location or at the
specified time, call 925-313-6740 immediately
• We love the environment too,
but please do not carpool to the clinic
(you may be asked to switch locations)
Staff Instructions Cont’d
• There will be a staff break room but no secure
area for valuables so please leave them at
home!
• Bring only what is essential and what you can
carry on your person (fanny pack, wallet, keys,
etc.)
Staff Instructions Cont’d
• Please dress comfortably, but professionally –
these are still clinics
• Wear sensible shoes!
• Breaks and a meal will be provided
(between 4 – 6 pm boxed lunches
will be served)
When You Arrive at the Clinic
• Proceed to the Staff Registration Area
• Check in and sign all required paperwork
• Put on your assigned vest
• Check the org chart
and identify:
– the POD Site Manager
– the Safety Officer
– your Supervisor
– your position
When You Arrive at the Clinic
Cont’d• Check in with your supervisor
• Find your station
• Review your JAS or other written station duties
• Participate in the all staff briefing
• If you need to be vaccinated,
let your supervisor know
During the Clinic
• Do your job to the best of your ability
• If you feel you are unable to perform your
assigned function, notify your supervisor
• Be pleasant and
professional to clients
and other staff
at all times
During the Clinic Cont’d
• You may be asked to switch assignments
during the clinic by your supervisor.
• You may not switch
assignments without
notifying your supervisor.
During the Clinic Cont’d
• If media shows up, immediately direct them
to the POD site manager
During the Clinic Cont’d
• Work out with your
supervisor your meal break
(30 minutes)
• If you get injured, let your
supervisor and the Safety Officer
know immediately!
At the End of the Clinic
• Check with the POD Site Manager for
instructions if there are still people waiting or
arriving at the clinic
• Assist with packing up supplies
• Do not leave early - you MUST sign out before
leaving the clinic
• Turn in your vest and complete feedback form
• Clinic Management Positions
– POD Site Manager (overall clinic functions and
media). Maintains contact with Public Health
Operations (597 Center Ave.)
– Medical Operations Leader (all clinical
operations)
– Non-Medical Logistics Leader (all non-medical
activities and supplies)
POD Site Organization
Incident Command System (ICS)
POD Site Organization Cont’d
Incident Command System (ICS)
POD Site Manager supervises:
– Medical Treatment Supervisor (first aid)
– Health and Safety Officer
– Medical Operations Leader (all clinical operations)
– Non-Medical Logistics Leader (all non-medical
activities and supplies)
POD Site Organization Cont’dIncident Command System (ICS)
– Medical Operations Leader – oversees clinical
services (screening and vaccination). Reports to
POD Site Manager.
– Non-Medical Logistics Leader - oversees client
registration, clinic flow, special assistance needs.
Reports to POD Site Manager.
POD Site Organization Cont’d
Incident Command System (ICS)
POD Site Organization Cont’dIncident Command System (ICS)
POD Flow
• There are 3 main areas of the POD:
– Client Check-In
– Screening
– Vaccination
• PODs are generally organized the same
although clinic leadership can alter depending
on site and situation
Clinic Flow – Client Check-In
Client Check-In
• Distribute the numbered form
– Screening questions
– Demographic information (name, dob, address)
– Nurse-only portion for screener/vaccinator
• As number is called, make sure form is filled
out completely and you can read it
• Answer questions – if you don’t know, ask
supervisor
Clinic Flow - Screening
Screening• Verify client’s identity and date of birth
• Screeners will review the answers to the screening questions for each client and decide which vaccines and formulations they will receive by CHECKING the box next to the vaccine
• Give client the Vaccine Information Statements for the vaccines they are getting
• If you have a question, ask the Screening Supervisor
Screening Form
Clinic Flow - Vaccination
Vaccination
• Verify client’s identity and which vaccines they
are receiving
• Prepare and administer the vaccines
• Fill out the form with the site where you gave
each vaccine and sign/date the form – KEEP THIS
FORM
• Fill out the IZ Record for the client with name and
dob and indicate which vaccines they got - give
this to the client
Supplies• There will be people assigned to monitor supplies
at the clinic
• We are sending plenty of vaccine and medical
supplies, as well as non-medical supplies to the
clinic
• The Vaccination Sup and Medical Supply Sup are
responsible for keeping track of vaccines used
and doses remaining and giving updates to the
Medical Operations Leader who will give to POD
Site Manager
Special Assistance Supervisor
• Responsible for ensuring that all clients
receive best service possible
• Spanish-speaking staff at every clinic
• Other languages available via Health Care
Interpreter Network (HCIN)
• Work with Medical Operations Leader to
identify family/disabled space in vaccination
area
Questions?
• We have described the generic clinic flow,
leadership structure and reporting instructions
• Anything we forgot?
• The next section will be on screening and
vaccination assignments
• Thank you! We look forward to seeing
everyone there!
Screening and Vaccination
Overview
Screening
The Screener has four primary responsibilities:
– Verify patient’s name and dob
– Decrease the possibility of an adverse event or
reaction due to receipt of a contraindicated
vaccine
– Insure appropriate vaccines are offered and
information given
– Answer questions and concerns of the person
receiving vaccine
Screening Questions1.Have you had a serious reaction to any vaccine in the past? If yes, which vaccine?
¿Ha tenido una reacción grave a alguna vacuna en el pasado? Si contestó Sí, ¿a cuál vacuna?
2.Do you have a latex allergy?
¿Es alérgico al látex?
3. Do you have a fever today?
¿Tiene fiebre hoy?
4.Are you allergic to eggs?
¿Es alérgico al huevo?
5.Is there a history of Guillain-Barre syndrome ( a severe paralytic illness)?
¿Hay antecedentes del síndrome Guillain-Barre (una enfermedad paralítica grave)?
6.Do you have any of the following medical conditions or risk factors? Circle all that apply.
¿Tiene alguna de las siguientes condiciones médicas o factores de riesgo? Dibuje un circulo sobre todos los que se apliquen.
Asthma/Wheezing Anemia/Blood problem Heart disease
Asma/Respiración ruidosa Anemia/Problema de la sangre Enfermedad cardiaca pulmón
Lung disease Kidney disease Diabetes HIV
Enfermedad del Enfermedad del riñón Diabetes VIH
Cancer treatment Long- term steroid use Neurological problem (epilepsy)
Tratamiento por cáncer Uso crónico de esteroides Problema neurológico (epilepsia)
Cochlear implant Smoker Alcoholism
Implante coclear Fumador Alcoholismo
Daily aspirin use (applies to children 18 years and younger) Other
Uso diario de aspirina (se aplica a menores de 18 años) Otro_______________________
7.Do you have close contact with a person who is in a bone marrow transplant unit?
¿Tiene contacto cercano con una persona que esta en (need Spanish translation)?
8.Have you received any live vaccines in the last month? MMR, Varicella (Chickenpox)
¿Ha recibido alguna vacuna viva durante el mes pasado? MMR (paperas, sarampión, rubéola), Varicela
9.Are you pregnant? If the answer is yes, how many weeks? _________
¿Está embarazada? Si contestó Sí, ¿cuántas semanas? _________
Screening
• Form is formatted in English and Spanish
• All patient sections must be completed and
signed by the pt or pts representative
• Nurse-only section is at the bottom
• Screeners will CHECK the vaccines to be given
• Screener will give Vaccine Information
Statements
http://www.immunize.org/vis/
Nurse-only Section of Form
Vaccines Available
• 6 different vaccines are available
– 4 formulations of Flu vaccine
– Pneumococcal (Pneumovax)
– Tdap
Flu Vaccine
• Flu IM preservative-free 0.25mL (6 months through 2 years)
• Flu IM preservative-free 0.5mL (pregnant women)
• Flu IM 0.5 mL multi-dose vial, preservative present (3 years and up)
• Flu LAIV (FluMist nasal spray) 2 years through 49 years, only healthy persons, not pregnant
Thimerosal
California law requires the use of thimerosal-
free vaccines for children < 3 years of age and
for pregnant women
This means vaccine must be packaged in a single
dose vial or pre-filled syringe for these groups
Pneumococcal
Prevents disease caused by Strep pneumoniae
Given IM
Ages 19 years and up for persons with certain health conditions
Everyone ages 65 years and older
Do not give if allergic
• Chronic pulmonary ds
• Smoker
• Chronic cardiac ds
• Blood disorders
• Asplenic
• HIV/AIDS
• Diabetes
• Alcoholism
• Cochlear implant
TdapPrevents tetanus, diphtheria and
pertussis
Given IM
Ages 10 years and up
No minimum interval between Td and Tdap
Do not give
• encephalopathy occurring within 7 days of previous dose of Td, DTaP
• Guillain-Barre syndrome
• Arthus reaction
Priority groups include:
Pregnant women in 2nd or 3rd
trimester
Caretakers of infants
Screening
1.Have you had a serious reaction to any vaccine in the
past? If yes, which vaccine?
Determine which vaccine and severity of reaction
• Anaphylaxis (NO vaccines refer to provider)
• Hx Guillain-Barre (NO Flu, NO Tdap)
• Hx Encephalopathy (NO Tdap)
• Hx Arthus reaction (NO Tdap)
Screening
2. Do you have a latex allergy?
Products containing latex are the prefilled single dose
units of preservative free flu vaccine for use in
children< 3 years and for pregnant women
No latex in the gloves, needles, syringes used in these
clinics
No latex in Tdap or Pneumovax vaccines
Screening
3. Do you have a fever today?
If yes, do NOT give any vaccines
Refer to health care provider or
Provide the pt with information about regular
Public Health Immunization Clinics
Screening
4. Are you allergic to eggs?
If yes, what is the severity of the allergy?
Ask if they eat bakery items. If yes, then Flu
vaccine is ok.
Anaphylaxis is a contraindication for flu vaccine
Screening
5. Is there a history of Guillain-Barre syndrome
(a severe paralytic illness)?
If yes, do NOT give Flu vaccine
If yes, do NOT give Tdap
6. Do you have any of the following medical conditions or risk factors?
If the pt indicates yes by circling any
of the conditions listed below then they should not receive Flu LAIV (FluMist nasal); instead give injectable Flu vaccine
Asthma/wheezing
Anemia/ blood disorder
Heart ds, lung ds, kidney ds
Diabetes
HIV, cancer treatment
Long- term steroid use
Neurological problem
Daily aspirin use <18 yrs
These questions are also used to screen for indications for Pneumococcal (Pneumovax). If the following conditions are circled yes and the pt is 19 yrs and older, Pneumococcal vaccine may be indicated:
Smoker
Alcoholism
Cochlear implant
Lung disease
Blood disorder
HIV
Diabetes
Screening
7. Do you have close contact with a person who
is in a bone marrow transplant unit?
If yes, do NOT give Flu LAIV (FluMist nasal); Give
injectable Flu vaccine instead
Screening
8. Have you received any live vaccines in the last
month? MMR, Varicella, (chickenpox)
If yes, then do NOT give Flu LAIV (FluMist nasal);
instead give injectable Flu vaccine
Screening
9. Are you pregnant? If yes how many weeks?
If yes, give preservative-free, pre-filled syringe
dose of injectable Flu vaccine.
If 2nd or 3rd trimester, then offer Tdap if not
current
Pneumovax is contraindicated during pregnancy
Second Dose
• A second dose of flu vaccine is recommended
for some children between 6 mos through 8
years of age
• If the child did NOT receive any H1N1 vaccine,
they need a second dose of this year’s flu
vaccine one month later
• If this is the first year that a child is receiving
flu vaccine, they need a second dose of this
year’s flu vaccine one month later
Screening Recap
•Check the box next to the vaccine(s) to be given
•Provide Vaccine Information Statements for the
vaccines to be given
•Be prepared to answer questions or concerns pts or
parents may have regarding vaccines
Screening
• Questions?
Vaccination
• Verify patient’s identity and which vaccines they are receiving
• Prepare and administer the vaccines
• Fill out the form with the site where you gave each vaccine and sign/date the form – KEEP THIS FORM (put in Form Collection Box)
• Fill out the IZ Record for the patient indicating name, dob and which vaccines they got and give that to the patient
Vaccination
• All injectable vaccines will be
given with safety needles or
syringes
Vaccination
• Route - all injections are IM (intramuscular)
If you are uncomfortable administering a
vaccine to an infant, a clinic RN is available to
do this at all sites.
• Injection Site – either arm can be used.
Nurse-only Section of Form
Vaccination
• Must chart on the Nurse-only section of form:
– Lot number – most will be filled in
already
– Site (if injection)
– Nurse’s signature
Training Resources
• Eziz.org
• Video available from Erika Jenssen, 925-
313-6734
• Public Health Immunization Clinics – for
schedule see
http://cchealth.org/services/immunization
Vaccination
• Questions?
Thank you!
See you on November 10th!