Protecting Lives, One Vaccine at a Time The advancement of the pharmacist role in vaccination administration.
R. Kylea Goff PharmD Director of Pharmacy Norton Sound Health Corporation kgoff@nshcorp.org Heather Lefebvre PharmD, MBA, MSCR Director of Ancillary Services Norton Sound Health Corporation hbailey@nshcorp.org The presenters for this continuing education activity have no relevant financial relationships to disclose.
“ Hope lies in dreams, in imagination and in the courage of those who dare to make ” dreams into reality. Dr. Jonas Salk Medical Researcher and Virologist Developed the first successful polio vaccine
Objectives Identify barriers to vaccine delivery within a health system. 1. Discuss appropriate avenues to increase vaccine access. 2. Recognize health system and electronic tracking limitations and opportunities. 3. Distinguish misnomers in reported data to determine progress. 4.
Challenge You are sitting in a meeting and data is being presented on current vaccination trends in your health system. The numbers seem alarming, but you are not sure how to interpret the data you have been provided. Of what is presented, you recall these three “facts”: ● Percentage completion of primary series under age 2: 27% ● Percentage of adolescents who have received an HPV vaccine: 90% ● Percentage of patients who have received the flu vaccine: 35%
Savoonga, Alaska Norton Sound Health Corporation Umiak, an Alaska Native boat, found About Us on the shore of St. Lawrence Island. Shaktoolik, Alaska The Norton Sound Region comprises of A beautiful, sunny, summer day. a very remote area of Alaska. Accessible mostly by small airplanes where traditional healthcare is difficult to accomplish, Norton Sound Health Corporation provides services to Nome and 15 surrounding village communities that make up the Norton Sound Region. Our main campus in Nome includes an 18-bed inpatient unit and an 18-bed long-term care facility. Nome, Alaska Front entrance to the main facility.
Our Mission Increase vaccination rates throughout the Norton Sound Region by utilizing pharmacists and eliminating barriers to access.
Vaccination Barriers • Access to vaccines • Time & financial constraints • Documentation of vaccines into EHR vs IIS • Logistics of shipping vaccines due to the size of the region and location of the village clinics • Accuracy of vaccination records due to multiple reporting sources • Overcoming vaccine myths through education
Increasing Vaccine Access 1 Pharmacy-Driven Avenues 1. Clinics in Nome and in all village communities. 2. Integration into region’s school systems. 3. Access to all vaccines at pharmacy retail window including travel vaccines. 4. Offering vaccines during village clinic trips (i.e. semi-annual inspection trips). 5. Patient-focus outreach. 6. Integration into pediatric clinics.
Increasing Vaccine Access 2 Collaborative Agreement Expansion First collaborative agreement in 2013 included patients from 12 years of age and up with Influenza, Zoster, and Pneumococcal vaccines. Pharmacists & Medical Staff discussed expanding the population focus in the agreement to decrease barriers to access. P&TC agreed to allow pharmacists to vaccinate all patients with any recommended vaccine.
Increasing Vaccine Access 3 Community Healthaide Involvement Collaboration with Healthaide Training, Medical Staff, and Pharmacy to allow for CHAs to report to a pharmacist for vaccine recommendations and administration. Changes were made and approved in June 2019. CHAs are utilizing pharmacists more for vaccine questions-what is due and what can be given together. Pharmacists are fostering relationships and will continue to expand our role remotely in each village community.
Avenues of Vaccine Access Patient-Focused Outreach High-risk patients were identified through the EHR and cross-referenced with IIS to determine Idea which patients need to receive a pneumococcal vaccine. Patients Who Smoke Vaccine consent form was updated to help capture smokers. Patients who smoke are offered a pneumococcal vaccine. Discuss Execute Integration into the Region’s School Systems Consent forms are sent home to parents for the flu vaccines and vaccines are provided to eliminate parent burden.
Timeline of the Role of the Pharmacist Expansion August 1, 2012 December 31, 2019 10/1/2014 9/1/2017 9/30/2018 EHR GO-LIVE Pharmacist-Driven Flu Clinics High-Risk Patients 6/1/2015 9/1/2013 Across the Region for Pnemo Vaccines 3/13/2018 Expansion of RPh: 1st Pharmacist-Driven PEDS Team 3 New FTE Pharmacists Flu Clinics Developed 9/1/2019 8/1/2017 9/1/2018 Smoker Population for Expansion of RPh-Driven RPh-Driven Pneumo Vaccines Vaccination Administration 1/1/2018 Flu Clinics 8/12/2012 PILOT: Across the Region Pharmacists Were 6/1/2019 PEDS Trip 9/1/2014 9/1/2015 NOT Vaccinating CHA Integration Pharmacist-Driven Pharmacist-Driven Flu Clinic Flu Clinic 9/1/2016 1/1/2013 Pharmacist-Driven 1/1/2018 - 12/31/2019 AK BOP Collaborative Flu Clinic Incorporating 11/1/2017 37 PEDS Clinics + Agreement Approved Village Communities Shingrix Focus Increasing Pharmacists Vaccinations 10/1/2017 With pediatric patients Integration into Region School Systems
The Evolution of Vaccines Administered 2012 2013 2014 7,337 vaccines 7,468 vaccines 6,204 vaccines 2015 2016 2017 5,243 vaccines 7,467 vaccines 7,744 vaccines 2019 2018 5,991 vaccines 10,811 vaccines Vaccines are Increasing because of Pharmacists
Creation of the Norton Sound Region Children’s Coalition Pilot Project: January 2018 ● Pharmacist integration into pediatric ● clinics Core Team: Provider, Pharmacist, Nurse ● Support Staff: organizer, financial benefits ● coordinator, WIC Goal: increase monitoring of pediatric ● wellness/growth, developmental screenings, and vaccines rates Pharmacist Role: vaccinations and project ● management
Flu Campaigns
Limitations & Opportunities Not Accurate Date of Administration VacTrak Tools Optimal Reminder/Recall Lists: Active & Inactive Identifying correct patients Time VacTrak Clean-up Multiple accounts Consuming Patients move in and out of region Difficult to navigate TONS EHR Challenges Multi-step process to enter a vaccine Accuvax Implementation Bill as a prescription for vaccine cost Not Vaccine Billing Cannot bill for vaccine and administration Easy Roster Billing for Mass Flu Clinics
Challenge You are sitting in a meeting and data is being presented on current vaccination trends in your health system. The numbers seem alarming, but you are not sure how to interpret the data you have been provided. Of what is presented, you recall these three “facts”: ● Percentage completion of primary series under age 2: 27% ● Percentage of adolescents who have received an HPV vaccine: 90% ● Percentage of patients who have received the flu vaccine: 35%
Review of Data
Review of Data
Review of Data
Review of Data
Challenge You are sitting in a meeting and data is being presented on current vaccination trends in your health system. The numbers seem alarming, but you are not sure how to interpret the data you have been provided. Of what is presented, you recall these three “facts”: ● Percentage completion of primary series under age 2: 27% ● Percentage of adolescents who have received an HPV vaccine: 90% ● Percentage of patients who have received the flu vaccine: 35%
Challenge What can you do to increase access to vaccines within your health system?
Questions
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