EVERY SHOT COUNTS C O R O N A D O R O O M A U G U S T 1 6,

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1 EVERY SHOT COUNTS S TAT E I N F L U E N Z A VA C C I N E R E Q U I R E M E N T S T R A I N I N G F O R C O M M U N I T Y P R O V I D E R S C O R O N A D O R O O M A U G U S T 1 6, Nancy Knickerbocker State Flu Vaccine Coordinator County of San Diego Immunization Program 1

2 WHY DOES EVERY SHOT COUNT? Each year, on average, 5 to 20 percent of the U.S. population gets the flu. Roughly $87.1 billion is taken out of the economy each year due to influenza. During the flu season, 53 percent of deaths occurred in children who were at high risk of developing serious flu-related complications, but 47 percent of these children were healthy and had no recognized chronic health problems. A study published in JAMA last year found that adults who go a flu shot were 36% less likely to suffer a heart attack or stroke within the next year than those who weren t vaccinated. 2

3 WHY DOCUMENTING EVERY FLU SHOT COUNTS Last season you administered more than 56,000 doses of flu vaccine! Thank you for your hard work. By being good stewards of State flu vaccine, you not only reduced the burden of disease but decreased the number of unused vaccine by 5,000 doses from the previous flu season. WOW!! Food for thought: if just 20% of State flu providers miss documenting one dose of flu vaccine a month, that would add up to approximately 225 undocumented doses or $3,500 by the end of flu season.

4 DISTRIBUTION Remember, all personnel designated to pick up vaccine will need to present an ID. Warehouse hours: 8am-4pm (except noon to 1pm-Gino s lunch hour). Community Clinics who will be picking up flu vaccine for their whole organization will need to provide us with a list of the sites to which you will be distributing vaccine. -This list must include the flu products and the amount of doses each site will receive before you may pick up your organization s allotment. 4

5 -We will need to know the date when you will begin giving flu vaccine. -The work week is considered from Monday to Friday/Saturday. -The first State Flu Weekly report is due every Monday after you receive your initial state flu allotment. -All vaccine doses must be reported. -Even if you do not give flu vaccine the week the Flu report is due, submit the State Flu Weekly Report noting no vaccine was administered. -All State Flu vaccine inventory must be reconciled weekly and your SDIR/EHR Vaccine Usage Report has to be attached to the State Flu Weekly Report. 5

6 THINGS WE NEED TO KNOW If your Organization wants to add a new site (not listed on the MOA) to receive State flu vaccine, you must contact us first before you transfer vaccines to this site. We will need to have the site s contact information, Vaccine Coordinator s and backup s name, and amount of State flu vaccine transferred to them. You will be responsible for training the site to comply with the State flu vaccine requirements. 6

7 County of San Diego Immunization Program (SDIP) Website The SDIP website ( under the Health Care Professionals section, contains a new Influenza Information Webpage for Providers. Included in this webpage will be: -flu-related PowerPoints -guides for storage and handling -pertinent forms -influenza Vaccine Information Statements and more. 7

8 OTHER NEWS WORTH MENTIONING The State requires us to report flu vaccine usage intermittently. Reports to the State are due on: December 1 st, February 1 st, and July 1st. We will be tracking expiration dates of flu vaccine closely, notifying you to use vaccine the shorter expiration dates first. 8

9 Influenza Requirements for Tracking State Flu Vaccine Usage 9

10 STATE FUNDED FLU WEEKLY REPORT CHANGES 1) Fill in your Organization & Site info. 2) Fill in the date & amount of your initial flu allocation. 3) Enter the weekly report dates. 4) Enter all of your state flu products & their Lot #; tally every dose of each vaccine administered by indicating the patient s age range, and finally total the number of doses given per vaccine. 5) Every week you are required to do a manual count of your state flu vaccines, enter the doses on hand, and the number of doses wasted & extra. NOTE: EXPIRED DOSES ARE NOT WASTED DOSES! 6) Note if you transferred, received, or returned any State flu vaccine during the reporting week. 7) Check if you entered vaccines into SDIR, are using an EHR, or gave no flu vaccines, & attach your weekly SDIR Usage or EHR Vaccine Usage to this report. 8) Print your name, sign, and date this form before submission.

11 All unopened/expired State flu vaccine must be returned to HHSA Rosecrans at the end of your organization s flu season (for Community Health Clinics that is July 1 st.) Wasted and opened expired vials) must be noted in Section 2. on the Weekly Flu report. Use W for wasted doses; use D for expired unopened vials you are disposing of at the end of the season. Example of section 2: 2. ACTUAL MANUAL COUNT OF STATE FLU INVENTORY DOSES AT THE END OF THE WEEK (the week is Monday-Friday/Saturday) Product Name & Lot # Number of Doses on Hand Number of Wasted Doses (or if you disposed of opened expired vaccine, Code W for wasted, D for disposed.) Example: FluLaval MDV, #F W: 1-(Got only 9 doses Number of Extra Doses (Multi Dose Vials only) from vial) Example: Fluzone MDV, # AB Got one extra dose from vial 11

12 STATE FLU DOCUMENTATION FOR COMMUNITY ORGANIZATIONS WHO ARE USING AN EHR OR ARE LOW TECH. SDIR! 12

13 NEW ADDITIONAL WEEKLY REPORTING REQUIREMENTS FOR NON-SDIR PROVIDERS AND COMMUNITY ORGANIZATIONS Community Health Organizations who have an Electronic Health Record (& do not use SDIR) will attach your EHR State Flu vaccine usage report to the Weekly State Flu Report General State Funded Seasonal Influenza Vaccine Weekly Report Contact Nancy Knickerbocker, State Flu Vaccine Coordinator, Phone: Please fax or this report to SDIP every MONDAY: Fax: ; Organization & Site: Vaccine Coordinator: Site Manager: Tel: ( ) Your EHR vaccine usage report must contain the Patient s name, age, date shot administered and the name of the vaccine given State Funded Influenza Vaccine Administration Record Organization: Site: Contact: Phone: Weekly report dates: Please attach this form every Monday along with the State Funded Weekly FLU Report to: Nancy Knickerbocker, State Funded Influenza Coordinator. FAX: sdir@sdiz.org Questions? Call the SDIR Help Desk: Date Vaccine & Lot # yrs Print Patient s Name Vaccine Administered-(ONE mo 18yrs 49yrs 59yrs 64yrs yrs Given VACCINE PER PAGE ONLY) 1 Information on the Initial Doses Received (ONLY need to complete this section for the 1 st weekly report) Product Name Fluzone IIV4 (MDV) Fluarix IIV4 Flulaval IIV4 Flucelvax IIV4 Fluzone PED PF Syringes) (MDV) (MDV) IIV4 (Syringes) Date of initial doses received Number of initial doses received 1. WEEKLY USAGE REPORT FROM: / / TO: / / (the week is Monday to Friday/Saturday) Product Name & Lot # Ages Ages Ages Ages Ages Ages 60- Ages Total years 65 + across & months years years years years years down 2. ACTUAL MANUAL COUNT OF STATE FLU INVENTORY DOSES AT THE END OF THE WEEK (the week is Monday-Friday/Saturday) Product Name & Lot # Number of Doses Number of Wasted Doses (or if you Number of Extra Doses on Hand disposed of opened expired vaccine, (Multi Dose Vials only) Code W for wasted, D for disposed.) 3. DID YOU TRANSFER, RECEIVE, OR RETURN STATE FLU VACCINES (RETURN TO ROSECRANS MEANS UNOPENED VIALS, PF SYRINGES or EXPIRED DOSES), DURING THE SAME WEEK OF THE REPORTING PERIOD? NO YES, please fill out the vaccine information in the section below: DATE Product Name & Lot # Number Method Name of SITE vaccines transferred to, received of Doses from or returned to HHSA Rosecrans) Transferred to Received from Returned to HHSA Transferred to Received from Returned to HHSA Transferred to Received from Returned to HHSA 4. DID YOU ENTER ALL ADMINISTERED STATE FLU VACCINES TO SDIR DURING THE SAME WEEK OF REPORTING PERIOD? (Check the appropriate box) Yes, please attach SDIR Vaccine Usage Report No (Attach EHR report) NO VACCINES GIVEN THIS WEEK Report submitted by (please print your name): Title: Phone: ( ) - Signature: Date: For internal use only (IZ staff): Reviewed/Entered Date: Initial: TOTAL VACCINES ADMINISTERED= TOTAL ALL COLUMNS -1- Community Health Organizations not using SDIR or an EHR will complete the State Funded Influenza Administration Record (see slide #11). 13

14 OTHER NEWS If your Community Clinic will be housing your flu vaccines in a pharmacy, your pharmacy is considered a separate site and will also need to submit a State Flu Weekly Usage Report. BTW: whatever accounting system your organization uses, your manual flu vaccine count should match your SDIR vaccine usage report, EHR usage report, Weekly Flu Vaccine Administration Report, and/or your weekly State Flu Weekly Usage Report. 14

15 State Funded Influenza Vaccine Administration Record Organization: Site: Contact: Phone: Weekly report dates: Please attach this form every Monday along with the State Funded Weekly FLU Report to: Nancy Knickerbocker, State Funded Influenza Coordinator. FAX: Questions? Call the SDIR Help Desk: Date Vaccine & Lot # yrs Print Patient s Name Vaccine Administered-(ONE mo 18yrs 49yrs 59yrs 64yrs yrs Given VACCINE PER PAGE ONLY) 1 THIS IS A TWO-SIDED FORM. Fill in your Organization s information Document only one flu vaccine & Lot # product per page! Fill in the Patient s name, date vaccine was given, the vaccine administered, and the age range of the Patient receiving the flu vaccine TOTAL VACCINES ADMINISTERED= TOTAL ALL COLUMNS -1- Total the columns of the vaccines administered per age range. 15

16 Every week you are required to do a manual inventory of State flu vaccine, note the doses on hand, the number of doses wasted, & the number of extra doses. Document if you received, transferred, or returned any State flu vaccine (from SDIP or to/from another site). We need this weekly form even if you do not give vaccines. Print, sign, date, and fill in your contact information. 1. Actual Inventory of Doses at the End of the Week (count at the end of last working day of the week) Flu Vaccine Name & Lot # Number of Doses on Hand Number of Wasted Doses (or if disposing of any expired opened multi dose vials. Note W for wasted, D for disposed of) Number of Extra Doses (more than 10 doses per multi-dose vial) 2. Did You Receive, Transfer (to or from), or return (expired unopened) Vaccines during the SAME Week of Reporting Period? No Yes, please fill out the vaccine information in the following section: DATE Flu Vaccine Name & Lot # NO VACCINES GIVEN THIS WEEK. Number of Doses Method Name of Site Vaccines Transferred To/From (or Returned to HHSA Rosecrans) FYI: getting nine doses Transferred to from a multi-dose Received from vial means one dose has been wasted, an Returned to HHSA Transferred to Received from extra dose is more than 10 doses from a Returned to HHSA Transferred to Received from multi-dose vial. Returned to HHSA Report submitted by (print your name): Title: Phone: ( ) - Signature: GENERAL INSTRUCTIONS FOR COMPLETING THIS FORM Date: Fill in your organization s name, site if applicable, the contact person, and the week range for this record (the week is from Monday to the end of your vaccination week, usually Friday or Saturday). THIS RECORD MUST MATCH THE STATE FUNDED INFLUENZA WEEKLY REPORT TOTALS. Print the patient s name, the date the shot was administered, note which vaccine product was administered, and check mark the patient s age range. Only one influenza vaccine product & Lot # per page. For example, if you are administering both Fluvirin and Fluzone, use one sheet for the Fluvirin and one for the Fluzone. The total number of doses per each vaccine product should equal the sum of the doses per age range. This will give you with the total counts for the weekly State Funded Influenza Report. Send this form, along with the State Funded Weekly Usage Report form, once you begin receive your flu vaccines until your organization ceases dispensing State Funded flu vaccine for the season. These two forms are due every Monday. The subject line in the fax or should be addressed as Flu Vaccine Weekly Report-date range in week, name of facility. Ask your backup person to continue sending the forms weekly, in the event the primary vaccine coordinator is absent or unavailable. Notify us as soon as possible if any of the contacts for State Funded Influenza have changed. When your State Funded flu season has ended, use this form to document your final count and/or if you are disposing of any opened vials and returning any vaccine. 16

17 ONCE YOUR WEEKLY FLU VACCINE REPORT IS COMPLETED Attach your weekly SDIR Usage or EHR to the Weekly State Flu Vaccine Report for the same date range. The totals from your manual count, SDIR count, and State Funded Weekly Flu Report should match. The subject line in the fax or should be addressed as State Flu Vaccine Weekly Report-with the weekly date range and the name of the Organization/Site/POD. The reports can be ed or faxed. FAX: to:

18 State Flu Vaccine and SDIR 18

19 SDIR VACCINE INVENTORY/REPORTS TRAINING If you have not taken the SDIR Vaccine Inventory & Reports training, the next one will be: Thursday, September 22 nd, From 9am to 12 noon, Here at Rosecrans. Contact Nancy Knickerbocker at or 19

20 SDIR users must enter State flu vaccine into the SDIR vaccine inventory within 24hrs. SDIP staff will review that the flu vaccine was entered correctly so that it displays on SDIR reports and the yellow card. 20

21 TO MAKE THIS EASIER, WE ARE PROVIDING YOU WITH SCREEN SHOTS OF HOW EACH STATE FLU VACCINE SHOULD BE ENTERED INTO SDIR: 21

22 SDIR DISCLOSURE STATEMENT Reminder: Parents/legal guardians and patients must be informed, at every visit, that their child s or their immunization record and TB test results will be shared. They have rights as outlined in the San Diego Immunization Registry Disclosure Statement. 22

23 First Search for the Patient 23

24 THE DEMOGRAPHICS TAB IMPORTANT: Before a vaccine can be selected from the Add IZ from Inventory link in the yellow Immunization tab, it will be required that a User must indicate the patient s vaccine source under the Vaccine Eligibility field. For State funded flu vaccine, select the State General Funding under the Vaccine Eligibility column by using the down arrow. 24

25 ADD IMMUNIZATIONS FROM THE ADD IZ FROM INVENTORY LINK 25

26 When a User selects State General Funding under the Vaccine Eligibility field in the Demographics tab, only State General Fund vaccines will display in Add IZ from Inventory link. 26

27 SCREEN SHOT FROM THE ADD IZ FROM INVENTORY LINK: WHEN STATE GENERAL FUNDING, IS SELECTED FROM THE DEMOGRAPHICS TAB The Lot Description (Lot Desc) column allows the vaccine coordinator to add comments about the vaccine in the Lot Details Section under the Vaccine Inventory link in the Utility tab/administration tab. Notice under the Vaccine Notes column, a description for age ranges for influenza vaccine will be included. This description is automatically added by SDIR when the vaccine is initially entered into the vaccine inventory by the vaccine coordinator/manager. 27

28 ENTERING NEW VACCINES. CLICK ON THE BLUE ADD NEW VACCINE INVENTORY LINK. 28

29 HOW YOU ENTER THE STATE FUNDED FLU VACCINE IN SDIR IS CRITICAL TO ACCURATE WEEKLY REPORTS! Why? Because State funded vaccine have specific display names connected with CVX codes. If you choose the wrong vaccine display name and/or manufacturer, your SDIR weekly report will be inaccurate. If this occurs, you will have to delete all the shots entered incorrectly and re-enter them using the correct vaccine display name and manufacturer. 29

30 ENTERING VACCINE INFORMATION Use down arrow to select vaccine. 2. Use the down arrow to select the vaccine Manufacturer. If there is only one Manufacturer for a vaccine, this field will automatically fill in with that manufacturer s name. 3. *Enter vaccine doses in the Incoming Quantity field only. If the vaccine comes in a multi-dose vial, check on the box next to Multi-Dose Vials. DO NOT ENTER in Quantity on Hand field. 4. The Use Today field will default to Yes. 5. Enter Date Received & Expiration Date fields. 6.The Warning field will default to 30 days. The Expiration/Warning Notice fields default to Yes. 7. When entering the vaccine lot number, always use the lot # on the vial. Capitalize any letters in the lot #. If the vaccine lot # has a dash followed by a number do not enter them (e.g., if the lot # is ABA , do not enter the -2). 8. You may enter a comment in the Lot Description field. 9. Use the down arrow in the Vaccine Source field to select State General Funding. Finally, click 30 the green Insert button.

31 The Lot Description comments will appear under the Lot Desc column under the Add IZ from Inventory link. Please note the User will need to scroll all the way to the right to view this information. 31

32 HOW TO MAKE AN ADJUSTMENT TO YOUR VACCINE INVENTORY Adjustments to your inventory are made whenever you: Add vaccines (e.g., vaccines with the same lot #, same expiration date, and same vaccine source) Waste vaccines (This includes if you got less doses from a multi-dose vial.) Transfer/receive vaccines to or from another provider, site, or POD. Make any other changes to your vaccine inventory. Next click on the blue Inv ID number next to the vaccine you want to adjust. 32

33 Let s waste a dose of Fluvirin MDV, Inv ID # 3794, by Making an Adjustment In your SDIR Vaccine Inventory, locate the Fluvirin #3794, and click on its blue Inv ID number. Go to Make an Adjustment and note the wasted dose. 33

34 DOCUMENTING EXTRA DOSES OF FLU VACCINE IN SDIR FROM MULTI-DOSE VIALS Once you ve clicked on blue Inv ID, go to the Make an Adjustment section. 2. Enter the Quantity (doses that are extra), and Date fields. 3. Under the Type field, click the down arrow to Other Incoming. Enter a Comment (e.g., extra dose.) 4. Click Insert. 5. Information is then documented under the Lot Activities Summary.

35 ADDING INCOMING VACCINES THAT HAVE THE Same Lot #, Same Expiration Date, & Same Vaccine Source (VFC, Private, 317, or ST) AS VACCINES ALREADY IN YOUR INVENTORY. A new incoming vaccine with the same lot number, same expiration date, & same vaccine source, as an existing vaccine in your SDIR vaccine inventory, is added to that vaccine by making an adjustment. Start by clicking on the blue Inv ID # of the Vaccine with the Same Lot #, Same Expiration Date, and Same Vaccine Source. Let s add 30 doses of incoming Influenza LAIV with the same lot #, expiration date, & same vaccine source as Influenza LAIV blue Inv ID # Notice there are 20 doses in the Qty (quantity) field. 35

36 Once you ve clicked on blue Inv ID # , go to the Make an Adjustment section. 2. Enter Quantity (30 doses) & the date you are adding this to the existing vaccine. 3. Under Type, use down arrow to select Doses Received from State Provided Vaccines & make a note under the Comment field. 4. Click Insert. 5. The Lot Activities Summary will note the added 30 vaccine doses. 6. The Total Adjustment & Quantity on Hand fields reflect the added 30 doses. 36

37 HOW TO MAKE AN ADJUSTMENT FOR THE DOSES YOU WANT TO TRANSFER TO OTHER SITES Once you ve clicked on the blue Inv ID # 3792, go to the Make Adjustment section. 2. Enter the Quantity (doses you are transferring), and Date fields. 3. Under the Type field, click the down arrow to Doses Transferred to Another Provider. Enter a Comment (e.g., where vaccine is being transferred, by whom). 4. Click the Insert button. 5. Information is then documented under the Lot Activities Summary. 37

38 USE THE WEEKLY STATE FLU REPORT TO NOTE ALL TRANSFERS TO AND FROM OTHER SITES If you did not receive or transfer any vaccines during the reporting week, check NO in Section 3. 38

39 IMPORTANT: You will also document how much flu vaccine you receive or transfer to another site. After you receive your initial flu allotment, you will document any further vaccines you receive from SDIP in Section 3. See Example below: 3. DID YOU TRANSFER, RECEIVE, OR RETURN STATE FLU VACCINES (RETURN TO ROSECRANS MEANS UNOPENED VIALS, PF SYRINGES or EXPIRED DOSES), DURING THE SAME WEEK OF THE REPORTING PERIOD? NO YES, please fill out the vaccine information in the section below: DATE Product Name & Lot # Number of Doses Method Name of SITE vaccines transferred to, received from or returned to HHSA Rosecrans) 11/5/2016 EXAMPLE: FLULAVAL Lot # FL Transferred to Received from Returned to HHSA 60 DOSES transferred to the Encanto site. Transferred to Received from Returned to HHSA 39

40 THINGS WE DO NOT WANT TO SEE IN SDIR Missing documentation-where did those doses go? 40

41 GONE BUT NOT FORGOTTEN How can -6 be incoming? Why weren t they entered into SDIR? 41

42 MISSING DOCUMENTATION? Missing documentation-why weren t the records unlocked? What does Inventory Reconciliation mean? 42

43 ARCHIVING STATE FLU LOTS All State flu lots must be at zero (0) doses before they can be archived. You must explain where every dose went in the Make an Adjustment section. Begin by clicking on the blue INV ID link of the State flu lot to be archived. 43

44 Archiving in 1, 2, 3 Steps 1. Select No in the Use Today Field. 2. Check the Archived box. 3. Click the Update button. 44

45 Running Your General State Funded Influenza Vaccine Usage Report It can be found by clicking on the Utility tab, then the blue Reports tab Click on the dark blue Reports tab 2. Put your cursor on the Immunization column 3. Click on Vaccine Usage report link. 45

46 THE VACCINE USAGE REPORT Select your Facility. Enter the IZ date range. Next to the Include field, use down arrow to select State General Funding. Select to run the report in a PDF or Excel Format. Click Submit. 46

47 CHANGES TO THE VACCINE USAGE REPORT The Vaccine Usage report gives you the number of vaccines given by dose, age group, and date range entered. The Grand Total and Patient Count are at the bottom of the report. A copy of your weekly SDIR Vaccine Usage Report or EHR report must also be attached to the State Flu Weekly Report and the counts must match. 47

48 THE SDIR DAILY IZ REPORT You can use the Daily IZ Report to compare the State Flu totals with the Vaccine Usage Report. Be aware the Daily IZ will also display State Tdap for those Providers who are enrolled in the State Tdap Program for pregnant women and their close contacts. Select your Facility. Enter the IZ date range. Select the age range. Select to run the report in a PDF or Excel Format. Next to the Include field, use down arrow to select State General Funding. Click Submit. 48

49 DAILY IZ REPORT The Daily IZ report can be compared with the Vaccine Usage Report. It will display the total patients by vaccine source as well as the total number of immunizations by vaccine source. 49

50 WHAT IF THE SDIR FLU VACCINE NUMBERS DON T MATCH? The most common reasons why the numbers don t add up: All vaccines, transfers, doses wasted, &/or adjustments have not been entered into SDIR. Vaccines were entered into Add IZ from Inventory with the wrong vaccine lot number or in error. Another scenario: the vaccine was entered into the EHR instead of SDIR. IMPORTANT: Always delete the vaccine if the lot number, the vaccine dose (e.g., an adult dose was entered instead of pediatric dose), and/or the type of vaccine were incorrectly entered. Re-enter the correct vaccine information in Add IZs from Inventory. Relying solely on your SDIR Vaccine Usage Report instead of doing a manual count and reconciling the vaccine numbers with the SDIR count. Computational errors. Check your weekly State Flu Usage Reports. The manual count, SDIR/EHR/Vaccine Administration count, and State Flu Weekly Report should all match. If you still can t balance the numbers, use your patient information system/billing report/ehr to generate the date range with the influenza vaccine and number and of patients to whom you gave vaccines. We can also run a Lot Usage report for you. 50

51 Finally, you can always call the County of San Diego Immunization Program for further assistance: Nancy Knickerbocker, State Flu Vaccine Coordinator Phone: Fax: Updated 8/16 51