SECTION 11 IMMUNIZATION WORK PLANS Table of Contents 1.0 ALL NURSES WHO ARE AUTHORIZED TO PROVIDE IMMUNIZATION IN THE YUKON WILL MAINTAIN COMPETENCE IN IMMUNIZATION AND ADHERE, TO ALL COLDS CHAIN PROCEDURES... 1 2.0 INFANTS AND YOUNG CHILDREN... 2 3.0 CHILDREN AND ADOLESCENTS... 4 4.0 ADULTS... 6 5.0 TUBERCULOSIS... 8 6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS... 9 7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS... 11 8.0 PERSONS AT RISK FOR RABIES... 13 9.0 PERSONS PLANNING INTERNATIONAL TRAVEL... 15 10.0 ALL AGES / SEASONAL... 16 11.0 OUTBREAK PLAN... 18
Page 1 1.0 ALL NURSES WHO ARE AUTHORIZED TO PROVIDE IMMUNIZATION IN THE YUKON WILL MAINTAIN COMPETENCE IN IMMUNIZATION AND ADHERE, TO ALL COLDS CHAIN PROCEDURES 1) a) successfully complete an immunization competence examination upon initial hire (within 6 weeks) and at the discretion of the Community Nursing Management b) review Immunization Competencies For Health _Professionals verification of immunization competence is completed certificate of competence is issued personal learning needs identified CNO will advise employee & PHCNIC/NIC when competence exam is complete and iphis account activated. 2) a)maintain immunization competence through completion of the immunization competence recertification examination every 2 years b) review Immunization Competencies For Health Professionals 3) review all communicable disease and immunization information distributed by Yukon Communicable Disease Control or Community Nursing Office. 4) ensure proper storage and handling of all vaccines and related drugs recertification of immunization competence exam certification maintained up to date personal learning needs identified review of Community Health Nursing Program manuals is included in orientation of all new employees cold chain standards maintained Eight weeks before recertification is required, exam will be sent to employee by CNO Tracking system for verification of review of all communicable disease and immunization materials (i.e. nurse initials) Adhering to procedures as outlined in the Immunization Manual
Page 2 2.0 INFANTS AND YOUNG CHILDREN By 6 years of age, 95% of children residing in the Yukon will be up to date in the primary immunization series, as per the current Yukon Immunization Schedule 1) complete a focused review of immunization rates for each vaccine for the following groups: 0 12 mths 12 36 mths 36 60 mths 60 72 mths using iphis every 2 months 2) incorporate immunizations into well child clinic visits eligible clients identified & notified review annual immunization rates (January) & discuss with Manager programming strategies reflect emphasis on improving immunization rates for each vaccine in each age category parents/guardian who refuse any or all vaccines for infant/child will have refusal documented in iphis documentation of primary immunization series at well child visits Audits through iphis run by nurse Facility specific and Yukon wide stats will be sent to each facility annually Use of "Exemption" in iphis. 3) implement a catch-up program for outstanding immunizations for children 3 years of age immunization status of 3 year olds indicates 95% are immunized to date (January) Facility specific and Yukon wide stats will be sent to each facility annually 4) incorporate immunizations into the pre-kindergarten health assessment immunization status of 5-6 year olds indicates 95% are up to date (January) work plan reflects immunization in pre kindergarten health assessments Facility specific and Yukon wide stats will be sent to each facility annually
2.0 INFANTS AND YOUNG CHILDREN (CONTINUED) Community Nursing Page 3 By 6 years of age, 95% of children residing in the Yukon will be up to date in the primary immunization series, as per the current Yukon Immunization Schedule 5) complete accurate documentation of immunization and vaccine-related events on the approved immunization record (iphis) review of immunization deficiency reports as received from CNO & all corrective action taken Immunization deficiency report sent from CNO educate clients, parents, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program chart reviews; monthend reports reflect education strategies Chart audits by PHCNIC/NIC 6) educate parents, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information participate in national / territorial communicable disease prevention and immunization research and campaigns chart reviews, monthend reports reflect education strategies work plan reflects participation Provide education at each client contact
Page 4 3.0 CHILDREN AND ADOLESCENTS 90% of children aged 7 to 18 years will be up to date with immunizations as per the Yukon Immunization Schedule except for MMR which is 95% 1) complete a focused review of immunization status for all vaccines of all 7-18 year olds at least twice a year April & Sept) using iphis. 2) incorporate immunization into the school health program 3) implement a catch-up program for outstanding immunizations at 15 years of age 4) complete accurate documentation of immunization and vaccine-related events on the approved immunization record (iphis) eligible clients identified & notified and offered vaccines review immunization rates & those due for vaccines programming strategies reflect emphasis on improving immunization rates with appropriate vaccines for this age group parents/guardian who refuse any or all vaccines for infant/child will have refusal documented in iphis work plan reflects school immunization strategies review of immunization status of 15 year olds indicates 75% are immunized to date (enter mth) annual review of immunization rates for 16 year olds review of immunization deficiency reports as received from CNO and all corrective action taken Audits through iphis by nurse Use of "Exemption" in iphis Audits through iphis immunization deficiency report provided by CNO.
3.0 CHILDREN AND ADOLESCENTS (CONTINUED) Community Nursing Page 5 90% of children aged 7 to 18 years will be up to date with immunizations as per the Yukon Immunization Schedule except for MMR which is 95% 5) educate clients, parents, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program chart reviews; month-end report reflects education strategies which are documented on month end reports Provide education at each client contact 6) educate parents, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information chart reviews, month-end reports reflect education strategies Chart audits by PHCNIC/NIC 7) participate in national / territorial communicable disease prevention and immunization research and campaigns work plan reflects participation
Page 6 4.0 ADULTS 75% of adults will be up to date with immunizations as per the Yukon Immunization Schedule 1) Formally review immunization eligibility for Td/Tdap on all adults at least twice a year immunization rates reviewed programming strategies reflect emphasis on improving immunization rates for each vaccine "Cognos" report sent to facilities by CNO upon request 2) incorporate immunization review with each client contact iphis review & client history inquiry reflects immunization status Demographic update by facility clerk Client(s) placed in wait queue Immunization history reviewed by nurse during all client contacts 3) implement a catch-up program for outstanding immunizations programming reflects strategies to improve adult immunization rates 4) complete accurate documentation of vaccinerelated events on the approved formats review of immunization deficiency reports received from CNO & all corrective action taken immunization deficiency reports sent from CNO.
Page 7 4.0 ADULTS (CONTINUED) 75% of adults will be up to date with immunizations as per the Yukon Immunization Schedule 5) educate clients, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program chart reviews, month-end reports reflect education strategies Chart audits by PHCNIC/NIC 6) educate clients, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information chart reviews, month-end reports reflect education strategies Provide education at each client contact 7) participate in national / territorial communicable disease prevention and immunization research and campaigns work plan reflects participation
Page 8 5.0 TUBERCULOSIS 100% of identified clients for TB screening will receive a tuberculin skin test in accordance with Yukon TB Standards 1) perform tuberculin skin test screening on candidates based on Yukon-specific and Canadian guidelines 2) complete accurate documentation of tuberculin skin test screening as per Yukon guidelines 3) forward tuberculin skin test screening results to Yukon Communicable Disease Control as per Yukon guidelines 4) educate clients, parents, caregivers, general public, and other professionals on tuberculosis and tuberculosis screening 5) participate in national / territorial tuberculosis surveillance, prevention, and screening campaigns and research chart reviews demonstrate tuberculin skin testing according to Yukon and Canadian guidelines Tuberculosis Screening HLTH 939 forms completed accurately & copy retained on client file chart reviews demonstrate that Tuberculosis Screening for HLTH 939 forms have been forwarded to YCDC TB Control work plan reflects public education programming on tuberculosis and tuberculosis screening chart reviews demonstrate client education on tuberculosis and tuberculosis screening work plan reflects participation Chart audits by PHCNIC/NIC Provide education at each client contact
Page 9 6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS 95% of health care providers and emergency responders will be up to date with immunizations as per the Yukon Immunization Schedule 1) offer EMS & health care personnel history inquiry reflects Immunizations and/or immunization status serology testing at every contact iphis review & client history inquiry reflects immunization status Review history at first contact and/or during orientation. 2) maintain a list of Hepatitis B vaccines given to EMS personnel list of completed Hepatitis B vaccines for EMS personnel sent to Financial Admin clerk by March 31st of each year for billing purposes list of Hepatitis B immunizations for EMS responders maintained 3) implement a catch-up program for outstanding reflect emphasis on immunizations programming strategies reflect emphasis on improving immunization rates for eligible recipients
Page 10 6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS (CONTINUED) 95% of health care providers and emergency responders will be up to date with immunizations as per the Yukon Immunization Schedule 4) complete accurate documentation of vaccinerelated events on the approved formats review of immunization deficiency reports received from CNO & all corrective action taken Immunization deficiency reports sent from CNO 5) provide education to eligible vaccine recipients on relevant communicable diseases and immunization chart reviews demonstrate teaching regarding communicable disease and immunization Targeted in service sessions Provide education at each client contact 6) inform health care providers and emergency responders of credible electronic resources for relevant communicable disease and immunization information chart reviews demonstrate teaching regarding credible electronic resources for information on communicable diseases and immunization
Page 11 7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS 95% of individuals with specific chronic diseases (i.e. Hepatitis, HIV, asplenomegaly transplant) will be up to date with client specific immunizations as per the Yukon Immunization Schedule 1) complete a focused review of immunization history for persons known to have specific chronic diseases / conditions (through use of chronic disease list) at least once a year iphis immunization record reviewed programming strategies reflect emphasis on improving immunization rates for each vaccine Review of iphis immunization summary 2) incorporate immunization review with each client contact 3) implement a catch-up program for outstanding immunizations patient history inquiry reflects inquiry as to immunization status programming strategies reflect emphasis on improving immunization rates in individuals with chronic disease Demographic update by facility clerk Client(s) placed in wait queue Immunization history reviewed by nurse during all client contacts
Page 12 7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS (CONTINUED) 95% of individuals with specific chronic diseases (i.e. Hepatitis, HIV, asplenomegaly transplant) will be up to date with client specific immunizations as per the Yukon Immunization Schedule 4) complete accurate documentation of vaccine-related events on the approved formats review of immunization deficiency reports received from CNO & all corrective action taken Immunization deficiency reports sent from CNO. 5) educate individuals with chronic disease on recommended immunizations according to their specific need chart reviews demonstrate education on recommended immunizations specific to client need Provide education at each client contact. Document recommendations 6) educate individuals with chronic disease on credible electronic resources according to their specific need chart reviews demonstrate education on credible electronic resources on immunization specific to client need
Page 13 8.0 PERSONS AT RISK FOR RABIES 95% of individuals at occupational risk for rabies will be up to date with rabies immunization as per Yukon Immunization Guidelines 1) perform rabies preexposure immunization as requested by members of the public with particular emphasis on high-risk persons including: veterinarians animal control workers wildlife workers hunters & trappers spelunkers environmental health workers handling specimens 2) educate high-risk persons and members of the public on rabies epidemiology, pathophysiology, risk, and prevention, as well as post-exposure management with each at risk client who presents, discuss the risks, benefits and side effects of the vaccine and risk of disease programming strategies include rabies education initiatives when required 3) participate in rabies investigation for possible rabies exposures chart reviews demonstrate accurate completion of a Rabies Investigation Form YCDC/EHS are provided all required information.
8.0 PERSONS AT RISK FOR RABIES (CONTINUED) Community Nursing Page 14 95% of individuals at occupational risk for rabies will be up to date with rabies immunization as per Yukon Immunization Guidelines 4) administer post-exposure management in consultation with YCDC chart reviews demonstrate YCDC nurse collaboration 5) complete accurate documentation of vaccinerelated events on the approved format review of immunization deficiency reports received from CNO & all corrective action taken Immunization deficiency reports sent from CNO. 6) participate in territorial surveillance campaigns work plan demonstrates participation.
9.0 PERSONS PLANNING INTERNATIONAL TRAVEL Community Nursing Page 15 95% of individuals planning travel abroad will be immunized as per Yukon, Canadian, and International travel guidelines 1) provide information on recommended immunizations specific to the client and travel itinerary 2) consult with Whitehorse Health Centre as needed for information on recommended immunizations 3) refer clients to Whitehorse Health Centre as required for specific immunizations (i.e. Yellow Fever) Travel Planning form reflects information given to the client Travel Planning form reflects appropriate consultation Travel Planning form reflects referral to Whitehorse Health Centre for specific immunizations. 4) provide recommended immunizations 5) complete accurate documentation of vaccinerelated events on the approved format 6) educate the client, parent, caregivers on other infection-control practices (i.e. mosquito bite prevention, hand washing, safety of drinking water, etc.) documentation of immunizations given accurately reflects recommended vaccines for specific travel. review of immunization deficiency reports received from CNO & all corrective action taken chart reviews demonstrate education on infectioncontrol practices related to international travel.
10.0 ALL AGES / SEASONAL Community Nursing Page 16 Influenza and pneumococcal immunizations are up to date in 75% of eligible recipients 65 years according to Yukon Immunization Guidelines 1) complete a focused review of influenza rates at least 2) complete a focused review of adult (>65 yrs) pneumococcal rates at least three times a year to determine eligibility 3) implement a campaign annually to immunize eligible clients 4) incorporate immunization review with each client contact 5) educate clients, parents, caregivers, general public, and other professionals on influenza and pneumococcal-related illness and immunization influenza review completed by mid September & high risk clients identified. pneumococcal eligibility completed in August, February and May clients who refuse pneumococcal vaccine will have refusal documented in iphis programming strategies reflect emphasis on improving immunization rates for influenza and adult pneumococcal rates in eligible populations Immunization rates post-campaigns reflect improved immunization rates. chart reviews reflect inquiry into immunization history. chart reviews and month-end reports demonstrate education initiatives. Immunization Audit in iphis for pneumococcal coverage & eligibility (Clerk or Nurse) Review of "Cognos" reports provided by CNO weekly during flu campaign Use of "Exemption" in iphis Review of iphis record at every client visit
Page 17 10.0 ALL AGES / SEASONAL (CONTINUED) Influenza and pneumococcal immunizations are up to date in 75% of eligible recipients 65 years according to Yukon Immunization Guidelines 6) educate clients, parents, caregivers, general public, and other professionals on prevention of communicable disease (i.e. hand washing) chart reviews and month-end reports demonstrate education initiatives. 7) educate clients, parents, caregivers, general public, and other professionals on credible electronic resources for information on influenza and pneumococcal-related illness and immunization chart reviews and month-end reports demonstrate education initiatives 8) Participate in national / territorial influenza and pneumococcal illness prevention and immunization research and campaigns work plan reflects participation.
Page 18 11.0 OUTBREAK PLAN Goal: Prevention of a vaccine-preventable disease in the midst of an outbreak of the disease, by providing access to and provision of immunization 1) assess the scope of the outbreak by: reviewing daily client logs for patterns maintaining a list through a log or database of clinical and/or lab-confirmed cases from time zero to the end of the outbreak copy of log/ database submitted to Community Nursing Office as directed (weekly, monthly) log/database is comprehensive and complete 2) complete a focused review of immunization status for community members, health care providers or other specific target population (upon direction from YCDC / Community Nursing Management) work plan (see #4) demonstrates immunization status, risk status of community members 3) ensure an adequate stock of vaccine and related supplies are available in the health facility adequate supplies are in place in a timely manner.
Page 19 11.0 OUTBREAK PLAN (CONTINUED) Goal: Prevention of a vaccine-preventable disease in the midst of an outbreak of the disease, by providing access to and provision of immunization 4) complete a work plan for targeted mass immunization including: mass public clinics home visits (as required) evaluation of immunization status work plan reflects various strategies to quickly boost appropriate immunization rates work plan submitted to Community Nursing Office as directed (weekly, monthly) 5) enlist adequate resource supports (clerical, community) to adequate clerical and other supports are in place to enable nurses to focus on 6) implement a mass community awareness campaign (or complement an existing territorial campaign) on the applicable communicable disease and immunization community awareness strategies implemented.
Page 20 11.0 OUTBREAK PLAN (CONTINUED) Goal: Prevention of a vaccine-preventable disease in the midst of an outbreak of the disease, by providing access to and provision of immunization 7) implement a mass immunization campaign target timeframes for campaign established & maintained 8) evaluate mass immunization campaign effectiveness by collecting data including: total number of clinical cases total number of lab confirmed cases total number of vaccines / doses given mortality numbers morbidity numbers 9) complete accurate documentation of immunization and vaccine-related events on the approved immunization record 10)collaborate in a timely manner with appropriate stakeholders (YCDC, Community Nursing Management, other agencies, general (public) database (see #1) is utilized to generate a final report incorporating key data as outlined in #8 database is forwarded to Community Nursing Office review of immunization deficiency reports received from CNO & all corrective action taken post-outbreak iphis review of immunization records including adverse events, contraindications, recommendations). facility staff, nursing managers, and appropriate stakeholders indicate satisfaction at level of communication. Immunization deficiency reports sent from CNO. Summary report will be generated by CNO