Part III: Documentation, Administration Fee, and Communicable

							Part III: Documentation, Administration
    Fee, and Communicable Disease
Objectives for Documentation, Administration
       Fee and Communicable Disease
 Participants will gain knowledge and
  enhance skills of current immunization
  issues by:
     Understanding the different types of
      documentation required when administering
      vaccines.
     Describing how and when an administration fee
      may be charged for giving state-supplied
      vaccines.
     Identifying the steps of a communicable disease
      investigation.
Documentation
What do you have to document?
 Foreach dose administered, you must
 record the following:
     The manufacturer
     Lot number
     Date of administration
     Administration site and route
     Date the relevant current VIS was given
     Date printed on the VIS, and
     Name, address and title of the provider who
      administered the vaccine
Vaccine Administration Record
Vaccines Administered Log
 Exemptions to Immunizations
 Onlytwo types of exemptions from
 required immunizations available in
 NC:

     Medical Exemption

     Religious Exemption
            Medical Exemption
   Licensed NC physician

   Does not require approval from the N.C. State Health
    Director.
      Physician’s Request for Medical
                Exemption
   Does require approval from the N.C. State Health
    Director.
         Religious Exemptions




 Written statement
    bona fide religious beliefs and

    opposition to the immunization requirements,

 Does not need to be notarized or prepared by
  attorney
 Does not need to be submitted to the State for
  review or approval.
  Non-Religious Personal Belief
 North Carolina does not accept philosophical
 exemptions for immunizations.
Refusal to Vaccinate Form
    Certificate of Immunization



What should be included?
   Name of the child                          Sex of the child
   Name of the child's parent, guardian,      Number of doses of the vaccine given
    or person responsible for the child
    obtaining the required immunization        Date the doses were given

   Address of the child and the parent,       Name and address of the physician or
    guardian or responsible person              local health department administering
                                                the required immunization and other
   Date of birth of the child                  relevant information
          Why is the Certificate of
         Immunization Important?
 Part   of the OFFICIAL medical record

 Required    to enter school
     Must show child received required vaccines
Translating Foreign Language Terms
   Vaccine
Accountability
    What is Vaccine Accountability?
   Vaccine accountability is a
    comparison of doses shipped
    to reported data

   Accurately documenting by
    reports or in the NCIR
    vaccine that was
    administered,
    wasted/expired, transferred,
    or inventory on hand
What is the Importance of Vaccine
         Accountability?
   Ensures sustainability of the
    North Carolina
    Immunization Program
    (NCIP)

   Unreported vaccines affect:
     Quality of data for clinical

      purposes
     Assessment results

     Funding
What is the Importance of Vaccine
         Accountability?
   Vaccines are EXPENSIVE!!
     Average inventory is $25,000


       Providers receive between 20
        and 50,000 doses of state-
        supplied vaccine in a year
       Yearly orders range from $400
        to $1,000,000
       An order of just 10 doses of
        every vaccine is over $8,000
   What Must be Accounted for?
All doses of any state-supplied vaccine:
    That you administer
   That fall on the floor and break
   That you draw up but don’t need
   That you transfer to or from another
  vaccine provider
  That expire before you can use them
    How are Doses Accounted for?
   Doses in Inventory:
     Inventory and properly reconciled



   Doses Administered:
     Record into the NCIR/on VALs



 Doses Transferred:
   Record transfers in the NCIR or Transfer

    Forms
 Doses Expired/Wasted:
   Report all expired/wasted vaccines
What about Wasted/Spoiled Vaccine?

 Before wasting vaccine - Call the
  Immunization Branch
 Document
 Return vaccine
                   Transfers
 Account for   every dose shipped

 Report   transfers and wasted/expired vaccine
   Borrowing/Replacing Policy
 Must   maintain adequate inventory

 Borrowing can  only occur when stock is
 inadequate because of:
   Delayed shipment

   Vaccine spoiled in transit

   New staff calculated ordering time

    incorrectly

 Vaccine must   be replaced within 90 days
           Documenting
     Borrowed/Replaced Vaccines
   Must be documented on a Vaccine Borrowing
    report

   Once vaccines are replaced, replacement date must
    be entered on the form

   Forms must be held in the provider’s office for 3
    years

   Provider may have only one occurrence within a
    12-month period
    Who Should be Accountable?
   Person who orders your vaccine
   Physician who signs the agreement
   Person who receives & stores your vaccine
   Staff who administer vaccine
   Person who records or enters doses given on VAL/in
    NCIR
   Front office staff
   EVERYONE!!!
  Benefits of Accurate Child Specific
Vaccine Administration Documentation
  In
    case of recall or revaccination you will be
  able to accurately identify patients

  Accurate recording could   prevent unneeded
  repeated doses

  Child specific documentation is shared with
  local health departments and becomes part
  of the patient’s immunization record
       Questions about
Documentation or Accountability?
Administration Fee
      Charging for Administering
           NCIP Vaccines
 Providers may  not
 charge for state-
 supplied vaccines,
 but may charge
 an administration
 fee for giving
 vaccines.
       Charging for Administering
            NCIP Vaccines
Private Providers
 Ifpatients are paying the administration fee
  out-of-pocket, private providers may charge a
  maximum of the state Medicaid rate.
 Theserates change, and are posted on the
  Medicaid web site.
 Ifa VFC patient/parent states an inability to
  pay, the fee must be waived, according to the
  vaccine agreement.
           Charging for Administering
                NCIP Vaccines
Local Health Departments
   As of 2009, LHDs may charge (if they choose to) the patient an
    out-of-pocket administration fee unless:
      The patient is uninsured or underinsured, and

      The family income is below 200% of the federal poverty

       level.

   If the patient/parent states an inability to pay, the fee must be
    waived, according to the NCIP vaccine agreement.

   The maximum a LHD may charge a patient out-of-pocket is
    based on the state Medicaid rate.
Questions about the Administration Fee?
Vaccine Preventable
  Disease Control
        Case Scenario:
Rash x 3 days
Temp = 102°
Conjunctivitis

Vaccine history- religious exemption
Recent foreign travel
     What Should You Do?
   Isolate


Call the Local
Health Department
               Reporting Timeline
 24   hours
7   days
 Reportbefore laboratory
 confirmation
 Report
       to local health
 department
 Localhealth department
 reports to state health
 department
                     Why Report?
 To   investigate
 Institute   control measures
 Reduce   exposure
 Limit   spread
            Common VPD Errors
 Serological testing    for Pertussis

 Failure   to Isolate

 Delay   in contacting the LHD

 Delay   in Treatment
 Questions
   about
  Vaccine
Preventable
  Disease
 Control?
Standards for Child and Adolescent
     Immunization Practices
           The Standards
 Availabilityof vaccines
 Assessment of vaccination status
 Effective communication about
  benefits and risks
 Proper storage, administration and
  documentation
 Implementation of strategies to
  improve vaccination coverage
     Put Your Knowledge into
            Practice!
          What 7 things must you
 Question:
 document for every dose of vaccine
 given?