Transcript Function of area

Massachusetts Department of Public Health
Training Module
ALL-STAFF BRIEFING
&
JUST-IN-TIME TRAINING
For a Clinic, EDS or POD
Presented by:
Barbara Coughlin, RN
Health Educator
Massachusetts Department of Public Health
November 15, 2010
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Objectives
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Identify leadership and direct supervisor(s)
Identify need for clinic/EDS/POD
Identify vaccine or medication to be distributed
Understand the operations plan
Describe facility and site layout
Describe safety, security & emergency plan
Understand job assignment(s)
Identify station assignment(s)
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All-Staff Briefing
Purpose: To inform and orient all staff
working at a clinic/EDS/POD on the
operations plan
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Sign-In / Sign-Out
Sign-in on arrival
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Record arrival time, name, address and other
info as requested
Receive job assignment & station
Receive supervisor’s name
Verify identification/credentials
Receive name tag, required attire
Sign-out on departure
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Record departure time
Return equipment and unused supplies
Secure sharps and biologics (if applicable)
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Leadership and Supervisors
(Chain of Command)
 Identify lead organization
 Identify lead staff:
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Incident Commander
EDS Director (if applicable)
Medical Director
Clinical Supervisor (patient care)
Clerical, Safety & Security Supervisor(s)
(patient flow)
 Know direct supervisor
 Make staff introductions
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Incident Command System (ICS)
 Abbreviated version of ICS:
 Flexibility
 Scalability
 Span of control
 Establishes chain of command
 All you need to know:
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direct supervisor
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Reason For Clinic/EDS/POD
 The infectious disease or agent
 The mode of transmission
(PPE and precautions recommended)
 The treatment or prophylaxis
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Overview of Operations Plan
Client flow from arrival to departure
Target population
Hours of operation
Capacity
Crowd control plan
Vaccine/medication(s) to be
administered or dispensed
 Workforce Protection Plan
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Overview (cont.)
 Required forms, documentation and
information
 Reporting problems and concerns
 How to access assistance
 Accommodations for individuals
requiring additional assistance
 Interpreters and Translated materials
(forms and screening)
 Staff breaks and shifts
 Clinic/EDS/POD breakdown, clean up
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Facility/Site Orientation
Emergency exits
Restrooms
Break area
Secure storage area for clinic supplies &
personal belongings
 Parking for staff
 Phone reception and availability
(cell and landline)
 Other communication devices in use
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Client Flow
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One-way flow of traffic in clinic
Provide assistance as necessary
Monitor for bottlenecks
Keep families together
Adjust assignment as requested in
order to remedy problems
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Start Here
Greeter/
Initial
Triage
Orientation/
Paperwork
Registration/
Forms Review
Important Note: Individuals may be sent to
Medical Aid and/or Support for assistance
at any point in the process. In addition,
health education may be taking place at
many points in the process.
Medical Aid and/or Support
Medical
Medical
Screening
Screening
Vaccine
Administration
Observation
(if needed)
Forms
Collection
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Exit
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Signage In Use
 Direct clients through site
 Designate areas of clinic/EDS/POD
 Provide information & instruction
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Safety & Security Plan
Goal: Ensure safe and secure clinic
operations for staff, clients, and supplies
 Staff lead for safety and security: (ICS)
Safety Officer, police, fire, EMS,
behavioral health & other staff assigned
 ALL staff have a role and responsibility in
safety and security
 Identify how to report concerns and
access help
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Safety & Security Plan (cont.)
 Client considerations: children, individuals
in need of assistance...
 Be alert to problems: frustration,
agitation, anxiety (diffuse and distract,
get help before escalation)
 Security of supplies: needles, syringes,
vaccine/medication, biohazards…
 Security for staff belongings: handbags,
phones, etc…
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Emergencies
 Adverse reactions to vaccine/medication
 Other medical/behavioral emergencies
 Police/security emergencies
 Fire emergencies
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Emergency Response
 Onsite emergency responders (whenever
possible)
 Community resources (ex. Fire, EMS,
Police, local hospital, etc)
 Emergency medical equipment, supplies,
and standing orders
 Orient staff to location and use
 Phone availability, location and 911
access
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Site and Plan
is divided into two sections:
 Clerical, Safety and Security
assignments and stations
 Clinical/Dispensing
assignments and stations
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Clerical, Safety & Security Areas
These areas encompass all staff and
assignments outside the clinical/
dispensing area
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Staff & Assignments in
Clerical, Safety & Security Area
 EDS Director/Incident
Commander
 Clerical, Safety &
Security Supervisor(s)
 Safety & Security staff
/Safety Officer
 Staff registration
person(s)
 Parking staff
 Greeter(s)
 Screener(s)
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 Registration staff
 Clinic flow staff
 Forms collection & data
entry staff
 Observation and exit
staff
 Interpreter(s)
 Escort(s)
 Behavioral health staff
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Clinical/Dispensing Area
 Area designated for vaccine or
medication administration/dispensing
 Limit access to this area to:
 protect privacy and confidentiality
 reduce noise and confusion
 support security and safety plans
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Staff & Assignments in
Clinical/Dispensing Area
 EDS director/Incident
Commander
 Medical Director
 Clinical supervisor,
other direct
supervisors
 Vaccine/medication
manager
 Vaccinator/medication
dispenser
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 Vaccinator /dispensing
assistant
 Clinical runner(s)
 Observation staff
 Emergency response
staff
 Behavioral health staff
 Interpreter(s)
 Escort(s)
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Clerical, Safety & Security
Staff
Just-in-Time Training
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Clerical, Safety & Security Staff
Training Objectives
 Describe job assignments
 Describe station assignments
 Identify direct supervisor
 Describe details of clinic flow
 Identify method of communicating with
Direct Supervisor and other staff
 Identify procedure to access supplies
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Clinic Flow Details
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Parking/drop-off
Entry
Orientation
Registration
Vaccination/dispensing
Observation
Exit
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Parking and Entry Area
Function of area:
 Provide drop-off for mobility impaired
 Escorts/assistance as needed
 Parking instruction
 Signage and info on target population
 Direct clients to entry
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Registration/Orientation Area
Function of area:
Distribute forms and provide assistance as needed,
provide relevant Information and instructions
 Disease Fact Sheet
 Vaccine/medication administration form
 Vaccination Information Statements (VIS)
 Medication information sheet
 Screening form
 Billing information form (if applicable)
 Consent form (if applicable)
 Release of information form (if applicable)
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Screening Area
Function of area:
Screening for contraindications or precautions to
vaccine/medication
 Assure appropriate forms are complete
 Assist with questions or refer to Direct
Supervisor
 Request an interpreter if needed
 Protect confidentiality and privacy
 Only ask “need to know” information for safe
administration of vaccine/medication
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Clinical/Dispensing Area
 Restrict access to clients ready for
vaccine/medication, their family, and
staff assigned to this area
 Assure appropriate forms are complete
before client enters dispensing/clinical
area
 Direct clients to appropriate station
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Observation Area
Function of area:
 Observe clients for 15-20 minutes after
vaccination
 Especially if first time receiving vaccine
 Be familiar with and monitor for signs
and symptoms of adverse reactions
 Provide educational materials,
entertainment and refreshments
(as available)
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Exit Area
Function of area:
 Collect forms (if applicable)
 Ensure client leaves with essential
documents
 Answer questions and report concerns
 Complete exit survey (if applicable)
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Clinical/Dispensing
Staff
Just-in-Time Training
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Clinical/Dispensing Staff
Training Objectives
Describe job assignments
Describe station assignments
Identify Direct Supervisor
Review standing orders
Locate emergency supplies
Describe screening, client education and
required documentation
 Describe contraindications/precautions
 Describe signs/symptoms of adverse
reaction
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Vaccine/Medication on Hand
 Manufacturer and formulation
 Review package insert
 Review VIS (if applicable)
 Other resources
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Standing Orders
 Vaccine/medication (specific)
Standing Orders
 Emergency Standing Orders
 Current and signed by Medical Director
 Location of orders on-site
 Location of emergency equipment,
medications and supplies
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Vaccine Information Statement (VIS)
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Vaccine specific
Required by federal law
Must be current edition (unaltered)
Must be given before each dose
Conveys risks and benefits of vaccine
Available in multiple languages
Provide opportunity for questions
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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
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Screening
 Vaccinator/dispenser responsible for
final review of screening questions
 Protect confidentiality and privacy
 Only ask “need to know” information for
safe administration of vaccine/medication
 Utilize interpreter if needed
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Required Documentation
for Administration of Vaccine
 Patient’s name
 Vaccine name, manufacturer, lot number and
expiration date
 Publication date on VIS, date VIS was given
 Anatomical site, route and dose
 Date vaccine administered
 Vaccinator’s name, signatures, credentials and
address (on file)
 Clinic name, address and contact person
 Signed consent is only required for children when
a parent/guardian is not present
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Documentation
for Dispensing Medication
 Patient’s name (date of birth)
 Age and weight (children)
 Medication name, manufacturer, lot number
and expiration date
 Route and dose
 Date administered
 Medication administrator/dispenser’s name,
signatures, credentials and address (on file)
 Clinic name, address and contact person
 If using Head of Household model: names,
ages, weight (children), medication allergies of
family members
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Documentation
Must be:
 Legible
 Accurate
 Complete
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Vaccinator/Dispenser Responsibilities
 Be informed about storage, handling, preparation,
administration and contraindications of
vaccine/medication
 Review package insert and standing orders
 Relay information on risks and benefits of
accepting or refusing vaccine/medication
 Screen for contraindications and precautions prior
to administration
 Seek Direct Supervisor when needed
 Be mindful of security and safety of vaccine/
medication, sharps and biohazards
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Responsibilities (cont.)
 Understand document used to record
administration/dispensing
 Complete required documentation
accurately and legibly
 Be able to access and use emergency
equipment
 Hold current licensure and/or certification
 Report adverse events (VAERS)
 Report vaccine/medication errors
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Vaccine Storage and Handling
 Maintain “cold chain” at your station
 Keep vaccine on a cool pack or in a cooler
 Protect vaccine from exposure to light
 If vaccine is pre-drawn at clinic, dispose
unused pre-drawn syringes at end of day
 Label opened unused vials with date and your
initials
 Go to Vaccine Manager or Direct Supervisor
with questions, concerns, problems or need
for additional vaccine
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Medication Storage and Handling
 Per package insert and
manufacturer’s instructions
 Be mindful of safety and security of
medication at your station
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Administration/Dispensing
Best Practice
Use 5 Rights of Medication Administration
 Right Patient: verify name and age, screen for
contraindications and precautions
 Right Drug: check label, verify appropriate for
age and by manufacturer
 Right Dose: determined by age or weight
 Right Route: IM, subcutaneous, PO, intranasal
 Right Time: refer to dosing schedules and
minimum intervals between doses
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Vaccination/Dispensing Station
Supplies
 Vaccine/medication
 Container for
vaccine/medication
with cold pack (if
appropriate)
 Safety
syringes/needles
(different sizes)
 Alcohol wipes
 Bandages (latex
free)
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Adhesive tape
Hand sanitizer
Gloves (latex free)
Sharps/biohazard
container
Appropriate
paperwork/pens
Tissue and paper
towels
Trash container/bags
Gauze
Ask Clinical Runner for additional supplies
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Vaccine/Medication Errors
 Report error and incidents immediately to Direct Supervisor
 Monitor client for adverse reaction (if appropriate)
 Frequently seen errors:
 Wrong vaccine or medication
 Wrong dose for age
 Wrong site, route or needle length
 Administering expired/recalled vaccine
 Wrong time, errors in spacing of doses
 Report vaccine/medication administration errors to the
Institute for Safe Medication Practices www.ismp.org
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ISMP
Institute of Safe Medication Practices
 Report medication/vaccine administration
errors to ISMP online at:
www.ismp.org
Institute for Safe Medication Practices
200 Lakeside Drive; Suite 200
Horsham, PA 19044-2321
Phone: 215-947-7797
Fax: 215-914-1492
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VAERS
Vaccine Adverse Event Reporting System
 Report all clinically significant postvaccination events via online, mail, phone
or fax
www.vaers.hhs.gov
VAERS
P.O. Box 1100,
Rockville, MD 20849-1100
1-800-338-2382 (phone)
1-877-721-0366 (fax)
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Safety Considerations
 Safety syringes: be familiar with product on
hand
 Post vaccination/administration observation for
15 – 20 minutes
 Security of vaccine, medication, needles,
biohazard/sharps container
 Needle Stick Policy
 Blood Borne Pathogens Policy
 Hand hygiene, sanitizer
 Gloves and personal protective equipment (PPE)
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Observation Area
Function of area:
 Observe clients for 15-20 minutes after
vaccination/medication
 Be familiar with and monitor for signs
and symptoms of adverse reactions
 Provide educational materials,
entertainment and refreshments
(as available)
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Clinical Resources
Package inserts
Standing orders
Quick reference guides
Drug handbook
Clinic Manual
Epidemiology and Prevention of VaccinePreventable Diseases (The Pink Book) from the
CDC
 Red Book: 2009 Report of the Committee on
Infectious Diseases from the American
Academy of Pediatrics
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Please join us for the other training
modules!
 Vaccine Management, Storage and
Handling: November 16th, 3:00-4:00
Available online soon!
 Vaccine and Medication
Preparation and Administration
 Planning a Clinic/EDS/POD
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The End!
THANK YOU!
Questions?
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