Vaccine Storage & Handling Online Ordering of Vaccine
Objectives for Storage & Handling of Vaccine After viewing this presentation, you will: o Understand the Vaccine Cold Chain o Understand the CDC & NSIP requirements for vaccine storage units o Temperature control of your vaccine storage units o Separating specific funding sourced vaccine in your storage unit o Understand the difference between “Wasted Vaccine” and “Spoiled Vaccine” o What actions to take when you see an alarm on the data logger o Emergency Transport of Refrigerated Vaccines
The Vaccine Cold Chain
CDC/NSIP Storage Unit Requirements VFC Vaccine Storage Units The CDC/NSIP highly recommends stand-alone refrigerators and freezers for VFC providers to store VFC vaccine. NSIP requires any provider replacing a combination refrigerator or freezer to purchase stand-alone units. This ensures they will not have any other temperature excursions and waste vaccine. NSIP must be notified that a new storage unit has been purchased . • After purchasing and installing the new unit, providers must get 5 • days of temps to ensure the unit is stable to put vaccine in it. In Southern Nevada, notify Dhon Urg that you are getting a new • unit in. Dhon will approve the new unit after 5 days of temps. In Northern Nevada, contact Glenn Witt (Vaccine Manager) or Dr. Pam Forest (Quality Assurance Manager.)
CDC/NSIP Storage Unit Requirements VFC Vaccine Storage Units A new storage unit must be large enough to store vaccine at the busiest time of the year without limiting air flow to the vaccine. A solid door on the refrigerator is better than a glass door when power outages happen. Should not have digital temperature controls (unless the unit is pharmaceutical grade). Dial type temperature controls give more accurate changes. The new unit should have sufficient room to store water bottles to stabilize temperatures. Dorm Style refrigerators are NEVER acceptable!
Storing Separate Funded Vaccine Types Always separate private vaccine from VFC/CHIP vaccine in your fridge and freezer. Store private vaccine on separate shelves from the VFC o Mark the shelves with “Private” or “VFC” o If you must store private vaccine on the same shelf as VFC Vaccine, o ensure the box the vaccine is in is marked appropriately
Expired or Spoiled Vaccine vs Wasted Vaccine Expired or Spoiled Vaccines: Nonviable vaccine in it’s original container (vial or syringe) that is able to be returned to McKesson for excise tax credit. This includes expired vaccine or vaccine that has been “Spoiled” due to: Natural disaster/power outage o Refrigerator too cold or too warm o Failure to store properly upon receipt o Spoiled in transit o Mechanical failure o Recall o Remove expired or spoiled vaccine from the storage unit and label “Do Not Use” Fill out Incident Report on what happened and what vaccines were effected Complete the UPS Label Request for Spoiled/Expired vaccines and fax to NSIP with the Incident Report. **Open multi-dose vials such as Polio, Zoster that have been spoiled cannot be returned to McKesson. Throw in Sharps Container** Unopened vials can be returned.
Expired or Spoiled Vaccine vs Wasted Vaccine Wasted vaccines are: Nonviable vaccine that is NOT able to be returned to McKesson due to: Vaccine drawn into a syringe but not administered o Vaccine in open vial but doses not administered o Compromised vial a broken vial, lost vial, or vial integrity/sterility o compromised **Expired “open” multi -dose vials of Polio or Zoster must cannot be o returned to McKesson**
Temperature Monitoring with Data Loggers NSIP has been providing free of charge the Tred30- 7R Log Tag temperature recorder since 2013. Pros Downloads data over email system to o multiple people Much more accurate than regular o min/max thermometers Provides clinics staff, NSIP, and the o manufacturers detailed information about temperatures the vaccine has been exposed to and for how long Easy to use o Comes with a 2 year Certificate of Calibration o Battery Operated o
Temperature Monitoring with Data Loggers Cons: Program on the computer for down loads must be under a specific user o profile No audible alarm, only visual o For some users, the digital readings are too small o If provider IT departments complete security o updates, the program setting can be erased
Actions To Take For Temperature Alarms When you see an alarm, you must take IMMEDIATE action! . STOP VACCINATING!!! 1. Immediately download (and send) data to the State 2. Analyze the data, and adjust the storage unit’s temperature accordingly 3. Contact the manufacturers 4. Complete a Vaccine Incident Report
Temperature Monitoring with Data Loggers What is wrong with this picture?
Temperature Monitoring with Data Loggers This graph shows min/max temperature checks
Backup Thermometers are a CDC/NSIP Requirement Backup Thermometers o As of January 2015, the CDC requires that all providers have a backup thermometer on hand. o NSIP cannot supply these to the providers. o It is not required to be a Data Logger, but it must meet the following standards: • Digital display on the outside of the storage unit. • Detachable probe in a bottle filled with thermal buffer such as glycol. • Has an alarm alert for out of range temperatures • Has a low battery indicator • Provides min/max temperatures
Backup Thermometers are a CDC/NSIP Requirement Backup Thermometer Requirements (continued) Comes with a Certificate of Calibration that calibration was performed by an • ILAC/MRA accredited laboratory or testing conforms to ISO 17025 requirements This backup thermometer can be stored in a convenient location but NSIP • recommends keeping the probe in glycol solution in the refrigerator so it is conditioned. In 2018, the CDC will be making a requirement that all backup • thermometers have to be a data logger .
Emergency Transport of Refrigerated Vaccine When power will be out longer than 2 hours at your clinic, you need to move the vaccines to another location. Always use a hard sided coolers or the Styrofoam vaccine shipping containers that came from McKesson. You will need the following supplies to pack the vaccines in the coolers 16 oz bottles of water that have been frozen Bubble wrap for insulation Corrugated cardboard cut to fit the dimensions of the cooler Data logger for temperature monitoring before, during and after transport of the vaccine
Emergency Transport of Refrigerated Vaccine Condition frozen water bottles • Use 16 oz water bottles for medium/large coolers or 8 oz water bottles for small coolers • Condition the frozen bottles by placing them in water or running under water. You want to see water starting to form near the surface of the bottle and it spins freely. • CDC recommends NOT using the coolant packs from the original shipping container. • After the bottles are conditioned, line the bottom of the cooler with the water bottles. Place bubble wrap over the water bottles so you have about an inch of of layer. Then place a piece of cardboard on top of the bubble wrap
Emergency Transport of Refrigerated Vaccine Place another open layer of bubble wrap in cooler on top of the cardboard and pack the vaccines on that. Place the glycol bottle for the data logger in the center of the vaccines so you get an accurate measure for temperatures. Place another layer of bubble wrap over the vaccines then a layer of cardboard over that.
Emergency Transport of Refrigerated Vaccine Lastly, place another layer of conditioned water bottles on the top layer of cardboard. Close the lid to the cooler ensuring the probe wire comes out to plug into the data logger. Start the data logger so it is recording the temps. This packing system has been tested by the CDC Storage and Handling Team It will keep your refrigerated vaccines at the proper temperatures up to 8 hours. If you had a temperature excursion during the transport, Mark the vaccines “Do Not Use” and store at the appropriate temperatures. Contact the manufacturers and NSIP until you know the vaccines are still good for use.
VFC Vaccine Online Ordering Through NV WebIZ
Objectives for Online Ordering through NV WebIZ After viewing this portion of the presentation you will: o Understand the level requirements for both your clinic and staff to be at in NV WebIZ to place orders o Understand how to reconcile in NV WebIZ if your clinic is using the HL7 connection o Understand where to go in NV WebIZ to place an order o Understand how to receive a shipment into inventory o Understand how to search for an order that you placed o Understand how to place a return through NV WebIZ
Place a New Order Before placing an order, you MUST reconcile the prior months inventory and close that inventory If you use an HL7 connection, you must complete your aggregate reporting of doses administered and close the reconciliation
Place a New Order Go to the Vaccine Orders Screen Then click on “Add New Vaccine Order” 4 1 2 3
Place a New Order Click on the arrow button to pull down the clinic name you are ordering for. Then click next 2 1
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