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Massachusetts Department Of Public Health Training Module

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Title: SETTING UP A CLINIC Author: DPH Last modified by: rschadt Created Date: 3/25/2010 12:46:28 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Massachusetts Department Of Public Health Training Module


1
Massachusetts Department Of Public Health
Training Module
Planning a Clinic/EDS/POD In Response to
Infectious Diseases, Emergencies, or Disasters
Presented by Katie Reilly, RN, BSN,
MPH Infectious Disease Response
Nurse Massachusetts Department of Public
Health November 12, 2010
2
Learning Objectives
  • Identify potential emergencies and emergency
    response
  • List steps in planning and operating a
    clinic/EDS/POD
  • Identify possible community assets and resources
    in response to public health threats
  • Consider plans for internal and external
    communication

3
An All-Hazards Approach to Planning
  • Are We Prepared?
  • Think Globally, Act Locally!

4
What Could We Be Facing?
  • Bioterrorist Attack
  • Anthrax, Plague
  • Infectious Disease
  • Influenza, SARS
  • Local Infectious Disease Response
  • Food Handler with Hepatitis A, Meningitis Case
  • Natural or Man-Made Disaster
  • Floods, Earthquakes, Nuclear events

5
Local Response
  • Timeline and scope of response depends on type of
    disease or incident
  • Identify site(s) where the local community will
    receive vaccination/medication
  • Staffing provided by local volunteers and
    professionals

6
The Team
7
Incident Command System (ICS)
  • Establishes Chain of Command
  • Abbreviated version of ICS
  • Flexibility
  • Scalability
  • Span of control
  • Most important thing to know
  • Direct Supervisor

8
Pre-clinic Planning
CDC
9
Planning team considerations
  • Target population
  • Required response
  • Capacity
  • Staff roles and job descriptions
  • Timeline
  • Location(s) and clinic flow
  • Communication
  • Security safety issues
  • Process of vaccinating/dispensing

10
Planning team considerations
  • Legal Issues
  • Jurisdiction
  • Public health laws, regulations standards
  • Licensure regulations
  • Liability protection
  • Consent (minor intellectually impaired)
  • HIPAA FERPA (privacy protection laws)
  • CORI SORI (criminal background check)
  • Record retention requirements

11
Develop an Operations Plan
  • Identify leadership
  • Identify space, location, dates, times of clinic
  • Obtain authorization from federal/state/local
    public health authorities (as needed)
  • Obtain signed standing orders (for vaccine or
    medication, and emergency)
  • Order and arrange for delivery and appropriate
    storage of vaccine/medication and clinic supplies

CDC
12
Develop an Operations Plan (cont.)
  • Identify staff/volunteers, assignments, job
    descriptions, necessary training and schedules
  • Verify current credentials/licensure of staff
    (e.g. CPR)
  • Obtain necessary paperwork/documentation/informati
    on
  • Assign set up, breakdown, and clean up duties
  • Determine client flow from arrival to departure

13
Develop an Operations Plan (cont.)
  • Capacity and estimated throughput
  • Safety and security plans
  • Accommodations for individuals requiring
    additional assistance
  • Just In Time Training (JITT), briefing and
    debriefing of staff
  • System to report problems and concerns
  • Method for disposal of sharps/biohazards

14
Staffing your clinic
  • Potential volunteer sources
  • Medical Reserve Corps (MRC)
  • Massachusetts System for the Advance Registration
    (MSAR) of Volunteer Health Professionals (VHP)
  • Civic organizations and faith-based groups
  • Schools, colleges/universities
  • Retired professionals
  • Citizen Emergency Response Teams (CERT)
  • Visiting Nurse Association (VNA)
  • Occupational Health Nurses (OHN)
  • American Red Cross (ARC)

15
Workforce Protection Plan
  • Developed to protect staff and encourage
    participation
  • Provides vaccine or prophylaxis to staff,
    responders, health care workers
  • Implement prior to opening site to the public
  • Use as opportunity to practice operations plan
    and modify as needed

16
Internal Communication Staff
  • When prior to, during and after clinic
  • Who all professionals and volunteers
  • How face-to-face, email, phones,
    walkie-talkies, social networking, HHAN
  • What plans, dates, times, locations, trainings,
    roles, schedules, supplies

17
Internal Communication Local Partners
  • When prior to, during and after clinic
  • Who public health, police, fire, EMS, MRC, MSAR,
    hospitals, private providers, neighboring
    communities
  • How face-to-face, email, phones, walkie-talkies,
    ham radio, social networking, HHAN
  • What times, locations, schedules, plans,
    trainings

18
Internal Communication State and Federal Agencies
  • When prior to, during and after clinic
  • Who MDPH, MEMA, MSAR, FEMA, CDC
  • How email, HHAN, websites, conference calls,
    webinars, webcasts, phones
  • What recommendations, guidance, resources,
    policies, procedures, timeline, capacity,
    surveillance reporting

19
External Communication Public
  • When prior to, during and after clinic
  • Who general/target/special populations
  • How newspaper, radio, TV, signage, Emergency
    Broadcast System (EBS), reverse 911, local cable,
    PSAs, Facebook, Twitter, blogs, websites,
    webcasts, webinars, interpreters, Connect - CTY
  • What rationale, recommendations, strategies,
    plans, education, times and clinic locations

20
Staffing Considerations
  • Target population
  • Severity of threat
  • Timeline/capacity involved
  • Demographics/special populations
  • Amount of vaccine/medication available
  • Staff available and their competency level
  • Screening process
  • Possible new and related cases of disease or
    potential exposure identified in subsequent days
  • Paperwork required (pre-populated)

21
Choosing Sites
  • Readily available, not already committed
  • Well known location(s)
  • Adequate accessible facilities consider
  • Floor space
  • Parking (staff/public)
  • Public transportation
  • Climate controlled
  • Refrigeration
  • Lighting
  • Restrooms
  • Kitchen area
  • Security (inside and outside)
  • Landline/cell phone reception/internet access

22
Consider Scheduling Clinics with Other
Events/Activities
  • Fairs
  • Sports events
  • Malls
  • Health screenings
  • Child safety events
  • Community events
  • Faith-based activities

23
Vaccine/Medication Management, Storage Handling
  • Points for vaccine/medication manager
  • to consider
  • Security
  • Transportation
  • Storage requirements
  • Follow manufacturers/MDPH recommendations on
    management, storage, handling and transport of
    vaccine/medication
  • Vaccine Unit 617-983-6828

24
Standing Orders
  • Use current standing orders that are reviewed and
    signed by a physician or medical director and
    have on-site (vaccine/medication specific
    emergency orders)
  • Orders should include name of vaccine/medication,
    dose, route/method of administration and
    inclusion/exclusion criteria
  • Model vaccine standing orders available at
    http//www.mass.gov/dph/imm

25

Designated Areas of Clinic
  • Parking/drop off
  • Entry
  • Registration
  • Screening
  • Vaccination/dispensing
  • Observation
  • Emergency treatment
  • Exit/collection of forms (optional)
  • Consider setting up in advance and combining
    areas and
  • functions based upon staff, population,
    facility.

CDC
26
(No Transcript)
27
Suggested Supplies Equipment
  • Tables, chairs, privacy screens
  • Refrigerator, coolers, thermometers
  • Office supplies and required forms
  • Phones/walkie-talkies
  • Paper towels, tissues, trash containers/bags
  • Signage
  • Refreshments for staff in a secure area

28
Suggested Vaccination/Medication Dispensing
Stations Supplies
  • Vaccine/medication
  • Cold packs w/plastic
  • containers
  • Needles (different sizes)
  • Safety syringes
  • Sharps/biohazard containers
  • Latex free gloves
  • Hand sanitizer
  • Pill crusher
  • Water/cups
  • Medicine cups
  • Teaspoons/bowls
  • Alcohol wipes
  • Gauze/bandages
  • Adhesive tape
  • Tissues/paper towels
  • Table coverings
  • Trash containers/bags
  • Required forms/pens

29
Safety Security Planning
  • Maintain a list of authorized staff for each
    clinic
  • Establish staff sign-in/sign-out procedures,
  • including identification (e.g. name tags,
    vests)
  • Develop policies and identify locations to secure
    vaccine/medication and supplies
  • Plan to flex staff to meet demand and avoid
    bottlenecks
  • Consider availability of police, fire and EMS

CDC
30
Crowd Control Planning
  • Designate personnel for crowd traffic control
    to
  • Hand out forms
  • Maintain order/diffuse tension
  • Update crowd about wait times
  • Answer questions and concerns
  • Make accommodations for individuals in need of
    additional assistance
  • May use ropes signage to direct traffic flow
  • Place Signage at a level where people can see

CDC
31
Signage for
  • Clinic location
  • Important information/instruction for target
    populations
  • One-way flow of traffic inside EDS
  • Diverse populations (use universal specific
    languages) as needed
  • Designated clinic areas
  • Entrances, exits, restrooms
  • Inside and outside facility

CDC
32
Clinic Set Up
33
Prior to Opening Clinic
  • Designate and set up areas and stations
  • Transport and secure vaccine/medication
  • Provide All-Staff Briefing and JITT
  • Ensure signage is posted and placed correctly
  • Vaccination/Medication provided to work force and
    their families

34
Staff Expectations
  • Wear appropriate attire
  • Arrive on time for scheduled shift
  • Sign in-arrival time, name, address, etc.
  • Sign out for breaks and at end of shift
  • Have picture ID, name tag, or vest
  • Receive job assignment/job action sheet
  • Receive Direct Supervisors name
  • Attend All-Staff Briefing and Just In Time
    Training (JITT)
  • Set up stations

CDC
35
Parking and Entry Area
  • Drop off for mobility impaired
  • Provide escorts/assistance
  • Parking instruction
  • Relay information to clients about
  • Target population
  • Vaccine/medication available
  • Hours of operation
  • Clinic flow
  • Provide interpreters

36
Registration/Orientation Area
  • Distribute necessary forms, such as
  • Disease Fact Sheet
  • Vaccination Information Statements (VIS)
  • Medication information sheets
  • Screening forms
  • Billing information forms (if applicable)
  • Consent forms (if applicable)
  • Release of information forms (if applicable)
  • Assist with form completion and answer questions
    as needed
  • Consider posting forms online ahead of time,
    and/or distributing at libraries, city hall, fire
    station, etc

37
Screening Area
  • Screen for contraindications or precautions to
    vaccine/medication
  • Answer questions or refer to Direct Supervisor
  • Protect confidentiality and privacy
  • Ask only need to know information for safe
    administration of vaccine or medication

38
Clinical/Dispensing Area
  • Appropriate forms should be completed before
    entry into clinical/dispensing area
  • Staff/signage will direct clients to appropriate
    station
  • Administer vaccine/dispense medication
  • Restrict access to this area in order to
  • Reduce noise and confusion
  • Protect privacy and confidentiality
  • Support safety and security plans

39
Vaccine/Medication Preparation, Administration
and/or Dispensing
  • Points to consider
  • Policies and procedures
  • Standing orders (signed)
  • Staff competencies
  • Vaccine/Medication Administration
  • Emergency Response
  • Medical
  • Facility
  • Manufacturers and formulations
  • Necessary documentation
  • Supplies

40
Clinical Documentation
  • Pre-populate forms if possible
  • Must be accurate, legible, and complete
  • Must be secured and retained
  • Consider electronic documentation
  • May provide vaccine/medication record
  • to the client
  • Provide VIS to client for immunizations

41
Required Documentation for Administration of
Vaccine
  • Patients name
  • Vaccine name, manufacturer, lot number,
    expiration date and dose number
  • Publication date on VIS, date VIS was given
  • Anatomical site, route and dose amount
  • Date vaccine administered
  • Vaccinators name, initials, signature, and
    credentials
  • Clinic name, address and contact person
  • Signed consent is not required except when a
    parent/guardian is not present

42
Vaccine Information Statement (VIS)
  • Conveys risks and benefits of vaccine
  • Produced by CDC
  • Required by federal law
  • Vaccine specific
  • Must use current edition and not altered
  • Give before each dose of each vaccine
  • Provide an opportunity to ask questions
  • Available in multiple languages at
  • www.immunize.org/vis

43
Medication Documentation
  • Patient name
  • Age, weight (children)
  • Type of medication
  • Manufacturer
  • Lot number and expiration date
  • Date the medication was administered/dispensed
  • Dose and route
  • Name and address of the clinic site and contact
    person
  • Name, initials, signature, and credentials of
    dispenser

44
Medication Information Sheet
  • Name and formulation of medication
  • Directions for use
  • Dosing administration information
  • Signs symptoms of adverse reaction/side effects
  • Contact information for questions or concerns

45
Observation Area
  • Observe for 15-20 minutes after
  • vaccination
  • Especially if first time receiving vaccine
  • Monitor for signs and symptoms of adverse
    reactions
  • Provide educational materials, entertainment and
    refreshments (as available)

46
Expect The Unexpected
  • Plan for emergencies with personnel, facilities
    and equipment/supplies
  • Obtain signed and current Emergency Standing
    Orders from physician or medical director prior
    to clinic
  • Model Emergency Standing Orders can be found
    at http//www.mass.gov/dph/imm

47
Emergencies
  • Adverse reactions to vaccine/medication
  • Other medical emergencies
  • Police/Security emergencies
  • Fire emergencies

48
Emergency Response
  • Onsite emergency responders
  • (whenever possible)
  • Community resources (ex. fire, EMS, police, local
    hospital)
  • Emergency medical equipment and supplies
  • Phone availability, location and 911 access

49
Emergency Supplies
  • BP cuff and stethoscope (child adult,
    extra-large cuffs)
  • Cell phone or access to an on-site phone
  • 3x3 gauze pads
  • Alcohol wipes
  • Bandages
  • Hand sanitizer
  • Latex free vinyl gloves (small, medium, large
    extra large)
  • Flashlight batteries
  • Thermometer probe covers
  • Instant cold packs
  • Cots, Blankets, Pillows
  • Wrist watch with second hand

50
Emergency Supplies, continued.
  • Acetaminophen 325 mg tablets
  • Ibuprofen 200mg tablets
  • Diphenhydramine 25 mg tablets
  • Diphenhydramine 50 mg injectable-(carpujet)
  • Diphenhydramine elixir
  • 12.5mg/5ml
  • suspension 25mg/5ml
  • Epipen Epipen Jr. Aqueous Epinephrine 11000
    injectable 1mg/ml
  • Syringes-3mL-1 23g, 5/8 25g, 1mL
  • Ammonia inhalant
  • Airways (large small)
  • Pocket masks with one way valve (adult
    pediatric)
  • Tongue depressors
  • AED

51
Exit Area
  • Collect forms (if applicable)
  • Answer questions and report concerns
  • Complete exit survey (if applicable)

52
Exit Survey
  • Consider surveying clients for relevant
  • information such as
  • How did you hear about the clinic?
  • How did you get to the clinic?
  • How long did you wait?
  • What did you like?
  • What didnt you like?
  • Where do you live?

CDC
53
Post Clinic Paperwork
  • Adhere to medical record retention rules for
    keeping administration records
  • Compile billing information (if applicable)
  • Complete MDPH Vaccine Aggregate Usage forms
  • Complete VAERS forms, incident and medication
    error reports if indicated

CDC
54
Post Clinic
  • Ensure proper storage and handling of unused
    vaccine/medication
  • Contact MDPH regarding unused and expired
    state-supplied vaccine/medication
  • Return equipment and unused supplies
  • Dispose of sharps and medical waste
  • Hold staff debrief/hotwash at end of clinic, or
    schedule a debriefing for later date
  • Ensure staff signs out

CDC
55
Staff Debriefing
  • What worked?
  • What didnt work?
  • Clinic challenges
  • Planning priorities for future
  • Future availability of resources
  • Additional suggestions/comments

CDC
56
Some Common Pitfalls in Planning
  • Assumption that everyone is on the same page
  • Different terms and concepts across disciplines
  • Too many spokespeople
  • Lack of training
  • Misinterpretation of roles

57
MDPH Contact Numbers
  • MDPH Epidemiology/Immunization Program
  • 617-983-6800 (24x7)
  • 888-658-2850
  • MDPH Vaccine Unit
  • 617-983-6828

58
Seasonal Flu Vaccine Reimbursement
  • Commonwealth Medicine (part of UMASS Medical
    School) is working with public private health
    plans to provide reimbursement for the
    administration of the seasonal influenza vaccine
    in the public setting.
  • Complete one insurance form for each individual
    who receives a vaccination
  • Have vaccine recipient, or parent/guardian sign
    and date the form
  • Fill out info in the Clinic/Office Use section
    for providers and sign and date the form
  • Submit forms via email or regular mail
  • Forms and more information available online at
    http//www.umassmed.edu/commed/flu-reimb/index.asp
    x

59
Online Resources
  • MDPH Guidelines for Compliance with Federal and
    State Vaccine Administration Requirements
    http//www.mass.gov/Eeohhs2/docs/dph/cdc/immunizat
    ion/guidelines_vaccine_compliance.pdf
  • MDPH General Protocol for Vaccine Storage,
    Administration, Standing Orders, Immunization
    Clinics, Sept 2009
  • http//www.mass.gov/Eeohhs2/docs/dph/cdc/immuniza
    tion/mso_protocols_general.pdf
  • MMWR General Recommendations on Immunization,
    Recommendations of the Advisory Committee on
    Immunization Practices (ACIP), December 2006
    http//www.cdc.gov/mmwr/pdf/rr/rr5515.pdf
  • CDC Guidelines for Setting Up Vaccination Clinics
    http//www.cdc.gov/h1n1flu/vaccination/statelocal/
    settingupclinics.htm
  • World Health Organization
    http//www.who.int/en

60
Online Resources
  • Massachusetts Department of Public Health (MDPH)
  • http//www.mass.gov/dph
  • MDPH Immunization Program
  • http//www.mass.gov/dph/imm
  • Immunization Action Coalition
  • www.immunize.org
  • Centers for Disease Control and Prevention (CDC)
    http//www.cdc.gov
  • Epidemiology and Prevention of Vaccine-Preventable
    Diseases, The Pink Book Course Textbook (11th
    Edition), May 2009 http//www.cdc.gov/vaccines/pub
    s/pinkbook/default.htmdownload  
  • Vaccine Administration Errors to the Institute
    for Safe Medication Practices www.ismp.org
  • Guide to Vaccine Contraindications and
    Precautions http//www.cdc.gov/vaccines/recs/vac-a
    dmin/downloads/contraindications-guide-508.pdf

61
Online Resources
  • MassPro for Flu clinic locations
    http//www.masspro.org
  • Adverse Events to Vaccine Adverse Events
    Reporting System (VAERS)
  • http//www.vaers.hhs.gov
  • School Located Vaccination Information for
    planners www.cdc.gov/h1n1flu/vaccination/slv
    /planners.htm
  • Massachusetts Division of Health Professions
    Licensure License Verification Site
    https//licensecheck.hhs.state.ma.us/mylicenseveri
    fication/
  • Sharps disposal companies from the Massachusetts
    Department of Environmental Protection
    http//www.mass.gov/dep/recycle/hazardous/medical.
    htm

62
Online Resources
  • Recommendations for Drawing-Up Vaccine and Other
    Documentations Requirements for Clinical Sessions
    or Large Clinics http//www.mass.gov/Eeohhs2/docs
    /dph/cdc/immunization/mso_recommendation_drawing_u
    p_vaccine.pdf
  • CDC Guidelines for Large-Scale Influenza
    Vaccination Clinic Planning http//www.cdc.gov/flu
    /professionals/vaccination/vax_clinic.htm
  • Commonwealth of Massachusetts, Department of
    Public Health, Emergency Dispensing Site,
    Management and Operations http//www.mass.gov/Eeoh
    hs2/docs/dph/emergency_prep/emergency_dispensing_s
    ite_intro.pdf
  • A Guide to the Massachusetts Public Records Law
  • http//www.sec.state.ma.us/pre/prepdf/guid
    e.pdf
  • MDPH Holding a Vaccination Clinic
    http//www.mass.gov/?pageIDeohhs2subtopicL8L0
    HomeL1ProviderL2GuidelinesandResourcesL3Gu
    idelinesforServices26PlanningL4Diseasesand
    ConditionsL5InfluenzaL6SeasonalFluL7Vaccin
    eAdministrationsidEeohhs2

63
Please join us for the other training modules!
  • All-Staff Briefing Just-In-Time Training
    November 15th, 300-430
  • Vaccine Management, Storage and Handling
    November 16th, 300-400
  • Vaccine and Medication Preparation and
    Administration available online soon!

4/2/2015
63
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