Developing An Immunization Program And “Sticking To It”

Developing an ImmunizationProgramand“Sticking to it”Rod Shafer, R.Ph.Executive DirectorWashington State PharmacistAssociationReasons for Involvement] Pneumococcal Disease\ 40,000 deaths per year\ 20% to 30% of high risk groups vaccinated\ Prevent up to 60% of hospitalizations] Influenza\ Up to 20,000 deaths per year\ 60% to 70% of high risk groups vaccinated\ Prevent 70% of hospitalizationsPneumonia & Influenza6th cause of death in the United States5th cause of death in the elderly 400,000 hospitalizations each year50% to 70% of those who die werehospitalized in the previous five years] 70% of those who die were seen by aphysician the previous year] Probably all of them seen by a pharmacist]]]]1

Vaccine Storage andHandlingKeep Refrigerator ColdKeep Vaccine Cold or FrozenKeep MMR Cold and Protected from LightKeep OPV FrozenKeep Varicella Frozen and Protected fromLight] Rotate Stock]]]]]Getting Started] Legal Requirements\ Scope of Practice\ Protocol Development] Space\ Privacy\ Prevent Injury] Personal\ Hep B Series\ CPR Training] Supplies/Equipment\\\\\\\\Sharps ContainerAlcohol SwabsBand-AidsSyringes/needlesDisposable GlovesGauze SquaresEmergency KitDocumentation FormsEmergency Kit] Blood Pressure Cuff] Stethoscope] Epinephrine 1:1000[ EpiPen[ AnaKit] Anti-histamine] Tourniquet6

Adverse Reactionsto Vaccines] Fainting\ Immediate onset\ Be observant ofpatient behavior\ Place in recumbentposition\ Elevate feet\ Monitor vital signs\ Observe tillfunctioning normally] Anaphylactic Reaction\ Slow onset\ Symptoms[[[[[[[[[tingling sensationshives, itchingtearing or swelling eyessneezing, coughingtightness in chestrapid heart beatswollen tonguedifficulty breathinghypotensionManagement ofAnaphylactic Reaction]]]]]Call 911Lay patient flatLow BP elevate legDifficulty breathing raise headAdminister epinephrine 1:1000, IM or SQ\ Infant/Child - 10mcg (0.01mg) per kg, max of300mcg, repeat every 5 minutes if needed\ Adult - .3ml (.5ml max. single dose), mayrepeat twice every 10-20 minutesManagement ofAnaphylactic Reaction]]]]Monitor vital signsBe prepared to administer CPRNotify primary care practitionerComplete a Vaccine Adverse EventReporting System (VAERS) form7

Documentation Forms]]]]]Screening/AssessmentVaccine Information Sheets for PatientsConsent FormsPatient Records - Lifetime IM RecordPharmacy Records[ Hard copy/Computer] Provider CommunicationScreening Questions]]]]]]]]]Are you sick today?Do you have allergies to medications, food, or any vaccine?Have you had a serious reaction after receiving a vaccine?Do you have cancer, leukemia, AIDS, or any other immune systemproblem?Do you take cortisone, prednisone, other steroids, or anitcancer drugs?During the past year have you received a transfusion of blood or bloodproducts, or been given a medicine called immune (gamma) globulin?For women: Are you pregnant or is there a chance you could becomepregnant in the next month?Have you received any vaccinations in the past 4 weeks?Did you bring your immunization record card with you?Documentation Forms]]]]]Screening/AssessmentVaccine Information Sheets for PatientsConsent FormsPatient Records - Lifetime IM RecordPharmacy Records[ Hard copy/Computer] Provider Communication8

Work-Flow forImmunization PracticeWork-Flow forImmunization]]]]]]Offer or RequestedScreeningPatient Information/Consent FormPrepare Patient/VaccinateCollect the Money!Observe Patient (20 minutes)9

Marketing - Strategies] Letters/Postcards\ Provider\ Patients] Advertising\\\\Coalitions - ALA, AA, DOHEmployersIn-storeWord of MouthMarketing - Strategies] Diphtheria/Tetanus] Hep A & B\ everyone] Influenza\ 50\ high risk\ pregnancy] Pneumococcal\ 65 everyone\ 65 at high risk\ adolescents\ high risk]]]]]MMRVaricellaTravel VaccineDepo ProveraTB screeningReimbursementRod’s Rate SchResources]]]]Center for Disease Control and Prevention\ professional information\ consumer information\ en espanol\ fax information service\ international travel\ disease hotlineAmerican Lung AssociationNational Coalition for Adult ImmunizationsVaccine Adverse Events Reporting System 003800-822-7967Internet Resources]]]]]]]]Center for Disease Control:www. cdc.gov/CDC Travel:www.cdc.gov/travel/travel.htmlImmunization Action Coalition:www.immunize.orgNational Coalition Adult ex.htmlFood & Drug Administration: www.fda.gov/fdahomepage.htmlPharmacist Immunization Network: pi-net@listserv.oit.unc.eduRod Shafer, Washington Statershafer@wsparx.orgBuild your own NetworkFax and/or e-mail12

FluMist Influenza Virus Vaccine Live, Intranasal] Cold-adapted, temperature-sensitive,attenuated influenza virus vaccine\ Phenotypically and genotypically stable] Annual vaccine strains derived from type A andtype B Master Donor VirusesFluMist QFluMist is indicated for active immunizationfor the prevention of disease caused byinfluenza A and B viruses in healthy childrenand adolescents 5 – 17 years of age andhealthy adults 18 – 49 years of ageFluMist Storage and Handling] Stored at -15 C ( 5 F)] Can be thawed and stored at 36 to 46 for 60 hours] Once thawed never refreeze] Shelf life 9 month aftermanufactured or through end ofcurrent flu season13

FluMist Dosage & AdministrationQQQQFluMist is supplied in pre-filled single dosesprayers containing 0.5 mlStored frozen and thawed beforeadministrationDose 0.5 ml (0.25 ml per nostril)Dose scheduleAge GroupVaccination StatusDosage ScheduleChildren age 5 yearsthrough 8 yearsNot previously vaccinatedwith FluMist2 doses (0.5ml each, 60 14 days apart) for initialseasonChildren age 5 yearsthrough 8 yearsPreviously vaccinated withFluMist0.5 mL (1 dose)per seasonChildren and Adults age 9through 49 yearsNot applicable0.5 mL (1 dose)per seasonFluMist Should Not Be Used In] Individuals with underlying medical conditions that maypredispose them to severe complications following wild-typeinfluenza infection] Individuals with history of asthma or reactive airways disease\ Safety and efficacy not established] Persons with known/suspected immune deficiency\ Specific diseases and conditions\ Associated with immunosuppressive treatment] Persons unable to avoid close contact (e.g. household) withsevere immunocompromised host for 7 days after vaccination] No preference exists for inactivated vaccine use by health-careworks or other persons who have contact with persons withlesser degrees of immunosuppresion.Summary] FluMist is a non-injectable influenza vaccine forhealthy individuals 5 – 49 years of age\ May increase acceptance of flu vaccine in healthypopulations] FluMist provides a safe and effective addition tothe health care armamentarium for preventionof influenza\ Complementing currently available vaccine] FluMist permits earlier immunization of healthyindividuals] CDC Q&A web site:www.cdc.gov/ncidod/diseases/flu/laiv.htm14

\ICD-9 Code V04.8 V03.82 \CPT Code 90724 90732 \HCFA Procedure Code G0008 G0009 #1 Immunization Resource Immunization Action Coalition 1573 Selby Avenue, Suite 229 St. Paul, MN