Panorama Bulletin 0024 WHERE DO I DOCUMENT IN PANORAMA? Revised Sept. 2017

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1 providers will use the features in Panorama to document -relevant details (such as the s - function). A standardized approach to the documentation of these details should prevent extraneous clinical notes, prevent redundancy of information, protect sensitive information, enhance client privacy, & provide timely access to pertinent information. Remember to check Bulletins, Policies, & the User Guides for more information or consult your Super User or supervisor if you still have questions after reviewing this reference. Bulletin 0022 has information about publicly funded vaccine eligibility & risk factors used in Panorama. Refusals Refusals Refusals Refusals 1. Refusal of individual antigen(s) or vaccine agent(s) 2. Refusal of all vaccine agents 3. Refusal migrated from SIMS as a Special Consideration> Exemption> Refusal 4. Client now accepting a previously refused vaccine 5. Child eligible for early HB based on parental immigration t Client Refusal Exemption Enter an end date for refused vaccines to ensure the forecaster & reminder/recall remain functional for the next routine age/grade (or to accommodate parental request if appropriate) Refusal End date the Client but only if warning applies to this particular vaccine. If a duplicate special consideration exists, refer to revised bulletin Type Source To prevent reminder/recall from including those who have current valid refusal See tation of Refusal policy if client requests no future reminders. The exemption directives in #1 may be applied as clients are to be informed that all students are offered vaccines in Grades 6 and 8 if a current antigen refusal does not exis. Exemption - End date if conversation with client has occurred & the client is now accepting. If this is a second refusal (e.g. HPV in Gr. 8) then do not end-date or update the date field & enter a comment in the preexisting exemption Grant Exemption - End date if conversation with client has occurred Special Population - Children of Immigrants - Hepatitis B If adding end date then document reason as No longer applicable No longer applicable 1

2 6. Infant HB postexposure prophylaxis in hospital 7. Tdap given to expectant mother/ parent/ caregiver of a newborn < 5 yrs from last Td 8. People born since who live in Keewatin Yatthé, Athabasca or Mamawetan Churchill River health authorities or on reserves in Saskatchewan (excluding Creighton, Air Ronge & La Ronge) 9. Household/sexual contacts of individuals who use illicit drugs 10. Household/sexual/ close contacts of an individual with acute or chronic HB 11. Sexual partners & household contacts of individuals who use illicit drugs 12. Client with multiple sexual partners Post-exposure - Infant Born to HBsAg+ Mom or High Risk for HB - Greater than or equal to 2000 grams OR Post-exposure - Infant Born to HBsAg+ Mom or High Risk for HB - Less than 2000 grams Special Population - Parents/Caregivers of Newborns Special Population Hepatitis A Program Targeted Community Special Population Potential Exposure Hepatitis A Contact Hepatitis B Special Population Potential Exposure Hepatitis B Special Population Potential Exposure Hepatitis B t Client Only for infants who received HBIg: "It is recommended that these infants be tested for HBsAg and anti-hbs when they are at least 9 months old, and at least 1 month but no more than 4 months after their HB series is complete (CIG)." Post- vaccination testing for HB antibody is recommended 1 to 6 months after series complete. Type Source 2

3 13. Percutaneous or mucosal exposure (sexual assault, bite, etc.) 14. Woman of childbearing age with non-immune varicella serology 15. Student attending or accepted into a post-secondary health care program 16. Employee of RHA/SCA or FNJ 17. Employee of a private care home or a private practice (dentists, physio, private nursing service) 18. Male born since Jan. 1/06 who has an immune compromised condition other than HIV+ 19. Parent/client doesn t want all recommended vaccines given on same day Post-exposure Blood & body fluids. The Forecaster is not currently engaged for HB for this risk factor but will validate & forecast once a series has been initiated). Special Population Varicella nonimmune woman childbearing age Occupation - Health Care - Student Occupation - Health Care - RHA/SCA/FNJ Employee Occupation - Health Care - Non-RHA Employee t Client Post- vaccination testing for HB antibody is recommended 1 to 6 months after series complete. If vaccine series is not initiated at initial contact a Client could be added: Client is eligible for HB vaccine. As applicable At this time, the 3- dose HPV series only forecasts for HIV+ RF, so add a warning that he is to get a 3-dose series, not a 2-dose series. Sample warning: On DATE, parent/client requested that only vaccines A & B be given at visit. Parent/ Guardian/ Client Type Source 3

4 20. Nurse couldn't safely administer all vaccines the client is eligible for today 21. Child/client resistant to 22. Too ill to receive vaccine today 23. Nurse to consult MHO before administration of vaccine 24. Vaccine unavailable t Client Add MHO s recommendations. Choose as applicable: 1. Inadequate muscle mass for imms; OR 2. Nursing Clinical Decision Parent/ Guardian/ Client Serious illness - temporary Referred to MHO Vaccine Supply Issues 25. Client late Insufficient appointment time. 26. Client had to leave before vaccine could be given 27. Client unable to wait 15 mins 28. Panorama or local IT down 29. Eligible for vaccine but waiting for serological results 30. Live vaccine(s) forecasting but client stated they recently received a live vaccine that was not recorded into client s record 31. Client presents; unable to proceed until translation complete Insufficient appointment time Insufficient appointment time IT disruption Awaiting serology Recent administration of live virus vaccine Awaiting imms record translation Type Source 4

5 Varicella Disease Varicella Disease Varicella Disease History of Disease - Other History of Disease - Other 32. record has been requested for client prior to 33. report of varicella disease for client born since January 1, 2003 &/or who is in grade 6 & has a Special Consideration Precaution migrated from SIMS 34. report of varicella disease for client born before January 1, 2003 with a Special Consideration Precaution migrated from SIMS 35. Laboratory confirmed case of varicella disease 36. Serological evidence of measles, mumps, rubella, HA, or HB immunity 37. Client with chronic HB infection or immunity due to natural infection Offer Vaccine: Grant OR Refusal Chronic Condition - Liver Disease Hepatitis B t Client Delete the Client if pertains solely to varicella OR Update if pertains to more than one antigen by deleting varicella related information from the message box. Select Other health care provider reported no longer applicable as. Delete the Client if pertains solely to varicella OR update if pertains to more than one antigen by deleting varicella related information from the message box. Select Other health care provider reported no longer applicable as the reason. Delete Client indicating there is a SIMS titre in Imms History Interpretation. Awaiting imms record Type Source Add Effective To date to end this Special Consideration Precaution Delete the Special Consideration Precaution & enter Exemption as indicated below. Exemption ted Immunity Note: Effective From date defaults to today s date. Update with the most appropriate date (e.g. from warning, lab result, record) only if services planned or presents for service. If client requests to be immunized in the future: Requires serology to confirm immunity status t as follows: o Immune - update the Special Consideration- Exemption response to Lab Report. o Non-immune - add Effective To date to end this Special Consideration Exemption Exemption ted Immunity tation Exemption Exemption ted Immunity ted Immunity tation 5

6 History of Disease - Other History of Disease - Other 38. Client with HIV Immunocompromised HIV 39. Client with laboratory confirmed HC infection 40. Infant born to mother with HIV infection 41. Authorization from ID Specialist or Positive Living Program to proceed with Rot-1 for infant (preliminary test from NML is neg.) 42. Authorization from ID Specialist or Positive Living Program to proceed with live vaccines for infant (e.g., two negative tests from NML) Chronic Condition - Liver Disease Hepatitis C t Client "DO NOT GIVE ANY LIVE VACCINE(S) until consulting with a specialist or attending physician {phone #} & reviewing the specific schedule. "DO NOT GIVE ANY LIVE VACCINES. Call (PHONE NUMBER) to review the specific schedule for this individual. Authorization to proceed with Rot-1 received on {date}. PHN end-dates once both doses Rot-1 have been given. Add Effective To date (using today s date) to end date the warning from #39 above. Select reason as Retesting shows no longer applicable Type Source Severely immunocomprised. t for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG tation Suspicious family or medical history for immunodeficiency disorders. t for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG End-date Special Consideration - pertaining to Rot-1 by adding an Effective To date End-date Special Consideration - pertaining to all live vaccines by adding an Effective To date. 6

7 43. Person with a Primary Immunodeficiency disorder (as noted in CIG) 44. Immunocompromised Due to Treatment 45. Immunocompromised - Related to Disease Immunocompromised - Treatment Specify Immunocompromised - Related to Disease t Client "DO NOT GIVE ANY LIVE VACCINES. Call (PHONE NUMBER) to review the specific schedule for this individual. NOTE: Depending on the client s treatment-specific details either a &/or a Precaution may apply to specified vaccines. NOTE: Depending on the client s disease-specific details either a &/or a Precaution may apply to specified vaccines. Type Source Suspicious family or medical history for immunodeficiency disorders. t for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG See NOTE Precaution See NOTE See NOTE Precaution See NOTE Severely immunocomprised. Comment section may be used for charting. t for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG Immunosuppressed - risk assessment required. Comment section may be used for charting. Severely immunocomprised Comment section could be used for charting. t for all live vaccines - MMR, Var, MMRV, Rota, FluMist, oral typhoid, YF, OPV, Zos & BCG Immunosuppressed - risk assessment required. Comment section could be used for charting. 7

8 Other Circumstances 46. Blank forecasting for the following immunocompromi sed clients: Transplant Candidate or Recipient of Solid Organ/Tissue; Islet Cell or HSCT 47. Client has received a blood product that cannot be documented in Panorama (e.g., packed cells, WinRho SDF) 48. Client has received an immune globulin product 49. Client has haemophilia 50. Infant s mother took monoclonal antibodies during pregnancy 51. MHO client pre- or post- consult Enter applicable Risk Factor (e.g. Immunocompromise d - Transplant Candidate or Recipient - Islet Cell, etc.) Enter any applicable (e.g. Post- Exposure - Rabies, Post-Exposure - Tetanus-prone Wound TIg Needed, etc.) Chronic Condition - Bleeding Disorders Immunocompromised - Treatment Specify. t Client "DO NOT GIVE ANY VACCINE(S) Call (PHONE NUMBER) to review the specific schedule for this individual (BLANK FORECASTING rule in effect)." Severe Bleeding Disorder t pertinent details Note: At this time, Panorama does not identify interaction rules for immune globulin products & live vaccines Note: At this time, Panorama does not identify interaction rules for immune globulin products & live vaccines. Type Source Precaution Immunosuppressed-risk tation assessment required Set to end after 8 months of age. t as applicable Recent Administration of a Blood Product (document for measles, mumps, rubella and varicella- containing vaccines) Add Effective From & Effective To dates (refer to SIM Chapter 5) Recent Administration of a Blood Product (document for measles, mumps, rubella and varicella- containing vaccines). Add Effective From & Effective To dates (SIM Ch.5) Severely immunocomprised (t Rota) t as applicable 8

9 Other Circumstances Other Circumstances Other Circumstances Other Circumstances Other Circumstances 52. Infant receives measles-containing vaccine prior to first birthday due to travel to high risk area or due to potential exposure 53. Because of an individual s DoB, Men-C-ACYW-135 forecasts for an individual who was immunized with Men-C-C with their Grade 6 peers 54. Confirmed latex allergy As applicable: Travel Publicly Funded Contact - Measles t Client Men-C-ACYW-135 is forecasting based of client s date of birth, and they were immunized for meningococcal disease appropriately in Grade 6. Latex allergy 55. History of fainting Note: Choose 1 of the vaccines given on day of event to document the SC, Event occurred when vaccines {date}. (All vaccines given on this date do not need to be specified because this will result in several client warnings instead of the 1 warning that is actually required). 56. Allergy to a vaccine component (i.e., eggs, thimerosal, etc.) Precaution See NOTE Precaution Type Source History of Syncope Allergy to a Vaccine Component t specific details in Comments field 9

10 Other Circumstances Other Circumstances AEFIs AEFIs 57. Student who gave mature minor consent for is concerned that their parent will see their history. 58. Whole cell pertussis (wp or wp) containing vaccine in client s history (e.g., DTwP-HB-Hib). 59. Mild to moderate vaccine side effects that do not meet the reportable AEFI criteria 60. AEFI submitted by PH or non-ph provider for nonreportable criteria. t Client profile is not to be sent to the student s home in grade 8. DTwP-HB-Hib antigens are not counted in the Antigen Count, but are valid doses; ignore the forecaster & provide appropriate number of doses of these antigens. AEFI report submitted for imms given on XXX, see imms details. Submitted for MHO review. Update (e.g.): Redness & swelling at injection site 5 cm diameter but not extending past next joint. Resolved within 48 hours." Type Source 10

11 AEFIs AEFIs AEFIs Unusual Events 61. Mild to moderate vaccine side effects that do not meet reportable AEFI criteria but PHN assesses she needs to alert next PHN to details 62. Severe, unusual, or unexpected vaccine side effect that meets reportable AEFI criteria & AEFI submitted. 63. MHO/MD recommendation for non-aefi issues 64. Vaccine given when special consideration exists t Client (E.g.): "See comments for DTaP-IPV-Hib on December 12, 2014 Expire this warning after next received & update comments as required. "Reportable AEFI for s on this date XX-XX-XXXX. See Imms. Submitted for MHO review. Refer to Bulletin 0028 for additional information regarding documentation. (E.g.)"See comments for (vaccine name) on XX-XX-XXXX." This warning could be end-dated after next received. Update comment field as required. Report form completed. See Comments for vaccine given date. (for all applicable vaccines) - Update (e.g.): Redness & swelling at injection site measuring 5 cm diameter but not extending past next joint. Resolved within 48 hours. Reaction appears to be more severe with each subsequent vaccine." t (for all applicable vaccines) - Update (e.g.): "AEFI meets reportable criteria - paper report dated XX-XX-XXXX. Provide details of AEFI. t (e.g.): "6 cm swelling at injection site but does not extend past joint. MHO recommends Benadryl prior to next " Note if SC was undocumented at time of. Detail in the Comments section of the indicated vaccine, including if was a provider error Type Source 11

12 Unusual Events Unusual Events Unusual Events Unusual Events Unusual Events 65. Vaccine prepared with expired diluent was. 66. Vaccine leaked upon administration & a second dose was 67. Vaccine by wrong route 68. Dose before minimum age or interval 69. Vaccine dose inadvertently missed t Client Report form completed. See Comments for vaccine given date. Report form completed. Report form completed. Report form completed. End-date once vaccine has been given. Provider error Invalidate this dose. Detail in the Comments section of the indicated vaccine, including if was a provider error t for the 1 st dose, "Mechanical malfunction while administering dose. Dose to be repeated. Then invalidate 1 st dose. t the second dose and ensure that is valid. Update: "Vaccine given SC instead of IM. Clinical recommendation to repeat dose the same day or reschedule according to min. interval rules. Report form completed. Type Source 12

13 Incomplete vaccine history, documentation unavailable Incomplete vaccine history, documentation unavailable Incomplete vaccine history, documentation unavailable 70. Parent indicates child (birth to grade 12) is up-todate with s but has no documentation. Vaccine series offered. Parent consents to booster doses only. 71. Parent indicates child is up-to-date with s but has no written documentation. Vaccines offered but parent refuses. 72. Foreign-born adult with no documented history. Vaccines offered. Grant Refusal Grant OR Refusal t Client "No documentation of historical vaccines available. Parent reports vaccines upto-date for age." Never to be enddated. Vaccines will continue to forecast as due until a complete series for age has been. Refer to #1 or #2 if appropriate. Do not override any dose numbers for a child with an undocumented history. No written documentation of historical vaccines available. Parent reports vaccines upto-date for age. Vaccines will continue forecast as due until a complete series for age has been. Do not override the dose number for a child with an undocumented history. If vaccine(s) refused: No written documentation of historical vaccines available. Client reports vaccines upto-date for age. Type Source 13

14 Incomplete vaccine history, documentation unavailable Incomplete vaccine history, documentation unavailable 73. Td- Revised Dose: Canadian-born adult with no written documentation of history but recalls having had childhood-/school s based on DoB (refer to SIM) 74. Canadian-born adult with no written documentation of history but recalls having had all childhood-/school s based on DoB (refer to SIM) t Client Client reports received all childhood/school vaccines but no written documentation available. Client reports received all childhood/school vaccines but no written documentation available. Revise to dose 4. Add Revised Dose Comment Accepting verbal imms history Type Source 14

15 Topic Prov. School Imms Strategy Refer to Panorama Mass Imms User Guide for more details. 75. not returned by targeted Grade student 76. not returned by non-targeted Grade student 77. Student absent at school for Grant or Refusal Client s s Communications Log Mass Imms Comments Topic Comments Client Event Status Absent Identify direction; identify communication type as applicable; topic is consent attempt Identify direction; identify communication type; topic is consent attempt For non- targeted Grade student Identify direction; communication type is in-person; topic is absent For targeted Grade student If second attempt to obtain consent, update Event Status to: Attempt 2 If third attempt to obtain consent Update Event Status to: Attempt 3 For targeted Grade student - Update MI Event Status to: Absent for (You can only do this once per worksheet so the second and subsequent absences would be with the communication log). 78. Contact attempt for (person of any age) Contact attempt Identify direction; identify communication type as applicable; topic is contact attempt 79. grant but student moves prior to immunized at school Ensure the Given By field includes the parent or guardian name, and Given To include the RN s name. For targeted Grade student - Update MI Event Status to: Moved out of School 80. Parent wants student immunized at health centre 81. granted; but waiting for client imms record For non- targeted Grade student t Will attend health centre for schoolage vaccines Awaiting imms record For targeted Grade student - Update MI Event Status to: To Be Seen at PHO For targeted Grade student - Update MI Event Status to: deferred NOTE: This deferral will not reflect on the client s Panorama record, thus a deferral must ALSO be created in the client s Panorama record. 15

16 82. grant erroneously documented by nurse Expire grant by placing client in context from the worksheet; then go to consent directive, add effective to date, and write consent was granted in error in comments and save. 16