covid-19 clinician support · 2021. 1. 19. · 1. epi report 2. swedish mass vaccine clinic 3. n95...

COVID-19 Clinician SupportJanuary 19, 2021

1. EPI Report

2. Swedish Mass Vaccine Clinic

3. N95 Guidelines

4. Vaccine Updates

We will have discussion and Q&A throughout the call. Use the “raise hand” function if you have a question

or comment.

Agenda

• COVID-19 Clinician Support Webinar• January 19th, 2021

• Scott Lindquist MD MPH

Washington State Department of Health is committed to providing customers with forms

and publications in appropriate alternate formats. Requests can be made by calling

800-525-0127 or by email at [email protected]. TTY users dial 711.

Swedish Mass Vaccine Clinic

Presenting

Renee Rassilyer-Bomers, DNP, CMSRN, RN-BCRegional Director Clinical Education and PracticeSwedish Health

Swedish CommunityCOVID Vaccine Clinic @ Seattle University

Renee Rassilyer-Bomers, DNP, CMSRN, RN-BC

TIMELINE

Week 1

• Notification New Year’s Day

• Call to Partnership with Seattle University

• Initial Meeting to Discuss Objectives

• SPARK selected for Volunteer Registration

• SOLV selected for Registration

• Playbook Version 1 Developed

• Facility set up (supplies, signage, technology, etc.)

• Walk thru completed and set-up refined

Week 2

• Monday Full Simulation

• Playbook Version 2 Developed with Simulation updates

• Tuesday January 12, 2021 First Clinic Day

• Playbook Version 3 Developed from First Day Clinic Experience

• Identification of Clinic Leads to support beyond initial roll out team

• Playbook Version 4 & 5 Developed from subsequent clinic days on Wednesday, Thursday, & Saturday

Week 3

• LEADS training priority this week

• Doubling of clinic opportunities to increase volume

• Starbucks Troyer Simulation Exercise Monday

5,214 Vaccinations Given

11,150 Vaccinations Scheduled

OVERVIEW

▪ Identify location and reserve the space

▪ Modify workflow to fit space

▪ Signage & Parking

▪ Physical Set-Up

▪ Secure and manage supplies

▪ Network bandwidth and maintenance

▪ Computers

▪ EVS, Parking, Entry Control Points

▪ Security

Clinical Operations Director (Leads the clinic)

Clinical Practice Supervisors (Supervises the vaccinators & clinical personnel)

▪ Observer Lead

▪ Vaccine Lead (Supervise vaccine dosing/distribution)

Non-Clinical Supervisor (Computer, database, document control, Way Finding, site coordination)

▪ Registration Lead

▪ Volunteer lead

▪ Entry Control and Way Finding lead

▪ WA ISS data entry lead

▪ Staffing and Supplies Coordinator

▪ Registration (Lead and Troubleshooting)

▪ Database/WAII/Data Entry (Lead & Troubleshooting)

▪ Vaccinators

▪ Escorts/Way Finders

▪ Observation (EMS, RN, LIP)

▪ Pharmacy & Techs

▪ Staffing Czar

▪ Supplies Czar

▪ Network bandwidth

▪ Emergency Medical Service: AMR coordinator

Lead Roles

02

Clinic Location

01

Clinic Staffing

03

Off Site Roles

04

Review WA DOH Off-Site Vaccination Clinic Guidelines

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/348-780-COVID-19Off-SiteClinicGuidelines.pdf

LOCATION

Campion Ballroom capacity = 195Chapel capacity = 31

*fire code with COVID restrictions on occupancy of 25%

Campion Ballroom

Clinic Schedule

Week One

Week Two

Week Three

Week FIVE-D1 and D2 Considerations

Appointment Registration

www.covidvaccineseattle.org

Screening Tool

SOLV Registration Link

Roles & Volunteers

OVERVIEW: Staffing Required for a RATE of 30 Vaccines/5 Minutes

Assignment License Rationale/Job Duties

Clinical Operation Director

1 Designee Oversite of the Clinic

Clinical Practice Supervisor

1 Designee Oversite of the vaccination area

Non-Clinical Supervisor 1 Designee Oversite of the non-clinical areas

Provider 1 Designee Consultation for patients & assist with emergencies

Pharmacy 1 Designee Responsible for vaccine

Leads 9 See Roles Vaccinator (2), Observer (1), Registration (1), Volunteer(2), ECP/Way Finder(2), WA IIS (1)

Vaccinators 32 RN/LPN/MA-C/Pharm D/LIP

Vaccinate, medication preparation, distribution of vaccine to vaccinators

Pharmacy (Vaccine Prep) 2 Pharmacy Tech, LIP, Pharmacist, RN/LPN/MA-C/

Assist Pharmacist, medication preparation

Resource 3 RN/LPN/MA-C/LIP Ability to vaccinate, observe, med prep etc.

Observer 4 RN/LIP/EMS ACLS certified in observation area (2 EMS/AMR)

Patient Registration 17 Any Volunteer; computer skills

Checking people in who have appointments

Volunteer Check-in 15 Any Volunteer Checking in the volunteers

Background Check 2 Designee Checking backgrounds on volunteers

ECP/Way Finders 40 Any Volunteer Directing patients through entry control and all clinic areas

WA IIS 35 Any Volunteer w/training Average computer skills and has been trained

TOTAL* 165 *Total not including the roles listed below:

▪ Supply Czar – Swedish MSC

▪ Staffing Czar

▪ EMS Coordinator

Parking, IT support, supply storage, facilities maintenance

OVERVIEW: What staff

can do what role

Nurse - LPN Medical

Physician Assistant LIP

Nurse - Registered (RN or advanced practice) Medical

Physician (MD, DO, DPM) LIP

Pharmacy tech Pharmacy tech

Pharmacist Pharmacist

Dentist (DDS, DMD) LIP

Nurse Practitioner (ARNP) LIP

Nurse Anesthetist (CRNA) LIP

Nurse Midwife LIP

Naturopath (ND) LIP

EMT/EMS/paramedic EMS

General Support General

Interpreter General

Medical Student (MD, DO, DPM) General

Physical therapist General

Occupational therapist General

Speech language pathologist General

Respiratory therapist General

Nursing student (RN, LPN) General

Medical assistant, certified (MA-C) Medical

Nursing assistant, certified (NA-C) General

Other Licensed professional General

https://volunteer.covidvaccineseattle.org/

Volunteer Block Schedule and Shift Change

Accountability Structure

Clinical Operations Director

Facilities Liaison

Manage site and storage

Parking, traffic control

EVS

Entry Control Point, Security

Clinical Practice Supervisor

Vaccine Lead

Vaccinator

Vaccine Prep

Pharmacy Tech

Resource

Observer Lead

Observer

EMS/AMR

Provider PharmacyNon-Clinical Supervisor

Registration Lead

Patient Registration

Volunteer Lead

Volunteer

Check-in

Background Check

ECP & Way Finder Lead

Entry Control Point

Way Finders

WA IIS Lead

WA IIS entry

OTHER

Network/IT support

Staffing Czar

Supply Czar

EMS Coordinator

Roles Responsibilities Expectations Qualifications

▪ Responsible for the operations of the clinic

▪ Huddle with volunteers to explain the day

▪ Coordinate with other leads to ensure efficient workflow

▪ Make in the moment decisions on “bottle necks”

and pinch points

▪ Assist with pre-training local resources; Ensure high level of

understanding for all roles and process

▪ Works closely with Clinical Practice Supervisor to ensure

best practices

▪ Issue resolution and escalation

▪ Supervise physical space preparation prior to clinic

opening and clean-up at close of clinic

▪ Work with Clinical Practice Supervisor to manage staff and

real-time resources and supplies as needed

▪ Ensure reactions are managed appropriately

▪ If EMS is transporting, have LIP in observation room

▪ Reviews playbook and roles prior to each clinic day for

workflow changes; reports any need for changes

▪ Responsible for reporting all issues appropriately

▪ Responsible for decision making regarding alibi dosing

▪ Present on-site in clinic

during open hours

▪ 60 minutes

before and

after clinic

hours

▪ Manage workflow

▪ Lead teams

▪ Commitment to 8+

hours per week

▪ Swedish Employee

▪ Local knowledge of

resources and processes

▪ Executive level

leadership skills: decision

making and authority

▪ Flexible

Roles & Responsibilities

Clinical Operations

Director

Clinical Operations Director


▪ Under direction of the clinical operations lead

▪ Manages the clinical staff

▪ Ensures staff are present

▪ Assign roles; adjust when needed

▪ Knows all clinical roles

▪ Huddles and just-in-time training

▪ Manages breaks

▪ Helps with supply management at each station

▪ Has a working knowledge of how many vaccines are on

the floor, how many are being made, how many people

are waiting for the vaccine

▪ Works with Supply Czar to ensure enough supply for the

day AND the next clinic shift

▪ Works with Staffing Czar if needed to ensure staffing is

adequate for next clinic

▪ Ensure all goggles, vests, and other surfaces are cleaned

at the end of shift

▪ Documents reactions and needle sticks appropriately

▪ Present/Available on-site during open hours

▪ 60 minutes

before and

after clinic

hours

▪ Swedish Employee



at facility site

▪ RN or LIP with strong

knowledge of best

practices



▪ Reports to the Clinical Practice Supervisor

▪ Utilize job aid provided at the stations

▪ Manages breaks with vaccinators and WAIIS

▪ Oversight on vaccinators and workflow of this portion of

the clinic

▪ Responsible for safety of medication preparation

▪ Distribute vaccination, maintaining appropriate chain of

custody

▪ Near the end of clinic work with the Pharmacy and Clinic

Practice Supervisor to ensure no vaccine is wasted

Present on-site in clinic

45 minutes before and

15 minutes after open

hours

Must review CDC COVID

Vaccination Guidelines

prior to fulfilling this role

RN or LIP with strong

knowledge of best

practices


https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html


▪ Utilize job aid provided at the station

▪ Fill out CDC Vaccination Record card legibly

▪ Screen for appropriateness to receive vaccine. Escalate

questions or concerns to Clinical Practice Supervisor or

LIP.

▪ Ask if this is first or second dose (If second dose, ensure

that the vaccine is the same as what is being

administered that day in the clinic)

▪ Administer the COVID-19 vaccine using correct

intramuscular injection technique (Deltoid)

▪ Direct to observation area when WA IIS entry is

completed

▪ Ensure caregiver has V-Safe information

▪ May fill other roles if needed

▪ Video Remote Interpreter station


Present on-site in clinic


15 minutes after open

hours

Must review CDC COVID

Vaccination Guidelines

prior to fulfilling this role

Administer vaccine

safely

Role can be filled by:

• MD

• DO

• DPM

• ARNP

• CRNA

• PA

• DC

• DDS and DMD

• Pharmacist

• Pharmacy intern

• Licensed midwife

• ND (naturopathic)

• ARNP students

• RN

• MA-C

• LPN

• Nursing tech

• RN students (as part of

a supervised cohort)


https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html



▪ Utilize medication administration safety measures, draw

up vaccine for vaccinator

▪ Write expiration time (1 hour) on label if NOT

drawn up at the vaccinator table

▪ Prepare using correct procedure from manufacturer

▪ Distribute vaccination, maintaining appropriate chain of

custody

▪ Monitor for potential medication waste (including

expiration), escalate as necessary to prevent waste.

▪ Assist and support vaccinator, monitor for supplies, etc.

▪ This role may flex as needed

Present on-site in

clinic 45 minutes

before and after open

hours

▪ Registered Nurse or

Licensed Independent

Provider

▪ Pharmacy Tech

▪ Comfortable with

medication preparation


Pharmacy Tech

Pharmacy Tech


▪ Under the direction of the Clinical Operational Lead and

the Clinical Practice Supervisor

▪ Utilizes job aids provided for role assigned

▪ Flex to Vaccinator and/or Observer as needed

▪ Ensure staff get breaks/lunch

▪ Duties as assigned

▪ May serve as a greeter outside:

▪ Welcome to Swedish/Seattle University clinic

▪ Today we are giving (insert) vaccine

▪ Please if you are experiencing any signs and

symptoms of COVID or are running a fever let

me know; we will get you another vaccine time

▪ Wait times are approximately: xxx

▪ Please read the EUA (Emergency Use

Authorization) which has all the information of

the vaccine today including ingredients

Present on-site in

clinic 45 minutes


hours

▪ Registered Nurse


identification of and

response to a reaction

to the vaccination

requiring intervention



▪ Reports to the Clinical Practice Supervisor


▪ Manages breaks

▪ Oversight on workflow of this portion of the clinic

Present on-site in

clinic during 45 minutes


hours



Provider

▪ ACLS preferred




to the vaccination





▪ In partnership with EMS, observe caregivers for reaction

post-vaccination

▪ Advise caregivers to rest for 15 minutes post-vaccine for

no history of prior reaction; additional 15 minutes if

needed

▪ Review Observation resources including how to

administer epinephrine IM

▪ Follow EMS’ protocol on anaphylaxis

▪ Monitor for signs of vaccination reaction including;

itchiness, angioedema, SOB; escalate immediately

▪ Reaction: Work with EMS during any urgent/emergent

situation. NOTIFY clinical operations lead and/or clinical

practice supervisor

▪ If EMS is transporting patient to hospital, ensure LIP is in

the observation area

▪ Document via the QRC provided on the job aid any

reaction that requires an intervention

Present on-site in



hours



Provider

▪ ACLS preferred




to the vaccination




▪ In partnership with Observers caregivers for reaction

post-vaccination

▪ Advise caregivers to rest for 15 minutes post-vaccine for

no history of prior reaction; additional 15 minutes if

needed

▪ Communication with Clinical Operation Director and

Observer Lead on any issues

Present on-site in



hours

▪ AMR

▪ EMT



▪ Under the direction of the Clinical Operational Lead and

the Clinical Practice Supervisor

▪ Utilizes job aids provided for role assigned

▪ Respond to provider-level questions, concerns, issues

involving patients, volunteers, and staff


Present on-site in

clinic 45 minutes

before and until last

newly vaccinated

patient has left

▪ Licensed Independent

Practitioner



▪ Collaborate with the Clinical Operational Lead during clinic hours to ensure optimal operations

▪ Oversight of vaccine preparation and management

▪ Manages flow of vaccines

▪ Has a working knowledge of how many vaccines are on

the floor, how many are being made, how many people

are waiting for the vaccine

▪ Manages supplies needed

▪ Sharps containers

▪ Vaccines

▪ Epinephrine for IM

▪ Present on-site

preparing vaccines for open hours.

▪ Present on-site in

clinic 45 minutes


hours

▪ Pharm. D.


LEAD Roles Responsibilities Expectations Qualifications

▪ Collaborate with the Clinical Operational Lead during

clinic hours to ensure optimal operations

▪ Partner with IT Lead to ensure hardware and network

readiness (Scanners, Laptops, etc.)

▪ Oversee technical operational functions

• Ensure correct processes being followed

• Train/educate staff

• Answer questions, resolve issues, escalate as needed

▪ Database issue resolution and escalation

▪ Manage laptops/security – storage if needed

▪ Trouble shoot WA IIS issues

▪ Present on-site

in clinic 45

minutes before and

after open hours

▪ Complete pre-

training with Regional Lead

▪ Strong leadership skills:

people, decision making

and authority

▪ Technically savvy

▪ WA IIS Access




▪ Verify caregiver is on sign-up sheet

▪ Send to Vaccine line

▪ If they are not scheduled escalate to Registration

Troubleshooting

Present on-site in clinic 45

minutes before and after open hours

▪ Any Caregiver (clinical or

non-clinical)

▪ Customer service skills

▪ Able to use a computer




▪ Entry control point for volunteers

▪ Downloads volunteer roster prior to clinic (hard copy)

▪ Present on-site in clinic


after open hours

▪ Can use a no-

touch thermometer

▪ Any qualification




▪ Entry control point for volunteers

▪ Check in Volunteers

▪ Any volunteer without employment badge must

obtain a background check

▪ Distribute vests and safety goggles to volunteers

▪ Collect all vests and safety goggles at the end of the shift;

clean per protocol


clinic during 60

minutes before and

after open hours

▪ Can use a no-

touch thermometer





▪ Escalate concerns to one of the Clinical Operation Leads


clinic 60 minutes


hours

▪ Appointed



▪ Utilize job aid provided at the stations

▪ ECP – Entry Control Point


clinic during 45

minutes before and

after open hours

▪ Can use a no-

touch thermometer





▪ ECP – Entry Control Point

▪ Screen all entering the vaccination clinic are free of COVID-

19 symptoms, and prevent risk of inadvertent transmission of

COVID-19

▪ All people are required to follow universal masking, hand

hygiene, and physical distancing. All people are required to

follow the screening process, which is subject to change. All

people are required to attest they are free of the following

COVID-19 symptoms in the last 24 hours, have their

temperature taken (symptoms subject to change), and

declare they have not been exposed to a person who is

COVID-19 positive within the last 14 days.

▪ Fever over 100°▪ Chills

▪ New cough

▪ Sore throat

▪ Shortness of breath/difficulty breathing

▪ Muscle or body aches (myalgias)

▪ Fatigue/feeling ill/malaise

▪ New loss of smell or taste

▪ New or unusual congestion/runny nose

▪ Nausea/diarrhea/vomiting

▪ New or unusual headache

▪ Do not allow anyone past the ECP who does not meet clinic

qualitificaitons

▪ Escalate all concerns to the Non-Clinical Lead, or the Clinical

Operations Lead

▪ Send to Way Finder to go to registration


clinic during 45

minutes before and

after open hours

▪ Can use a no-

touch thermometer




▪ Assigned to a vaccination station or “pod”

▪ Ensure workflow of pod

▪ Guide those vaccinated to observation lounge

▪ Assigned to registration

▪ Ensure workflow from registration to vaccination pod

▪ Help those getting vaccinated find their way

▪ Clean clipboards, pens, and surfaces after use.



clinic 45 minutes


hours

▪ Know workflow and

physical location





▪ Attend a 45-minute training session

▪ Collect documents from customer

▪ Enter demographic data

▪ Enter vaccine administration data

▪ Escalate concerns appropriately

Present on-site in clinic 45

minutes before and after open hours

HIPAA compliant

▪ Any Caregiver (clinical or

non-clinical)

▪ Technically savvy

▪ Must have WA IIS access

▪ Attended training session



▪ Collaborate with Clinical Operations Lead for operational

success of clinic

▪ Manages physical space

▪ Secured area (unlocks in am; locks in pm)

▪ Environment/Custodian Services

▪ Wi-Fi Issues; IT support

▪ Security

▪ Entry control point

▪ Set up/take down

▪ Parking; traffic control if needed

▪ Manage storage and receiving of supplies

▪ Supports issues during clinic hours of operation

▪ Present/Available on-

site during open hours

▪ 45-60 minutes

before and

after clinic

hours



at facility site


Workflows

SHIFT START/END HUDDLE

SHIFT END

CHECKLIST

❑ Ensure spaces are sufficiently picked up, including sharps and trash emptying, if needed

❑ Wipe everything down; storing supplies in a secure location

❑ Check supply par levels and request needs from MSC (see supply list with Lawson #s on SharePoint site)

❑ Escalate any unused vaccine to clinical lead and pharmacy lead

❑ Verify all staff have entered their shift information into the COVID Vaccination Clinic Form

❑ Debrief with group to learn from successes and opportunities

❑ Ensure all Potential Vaccination Adverse Reactions are entered on Forms (QR code on document)

SHIFT START

CHECKLIST

❑ Review location restrooms, exits, food and drink with clinical staff

❑ Identify each member of clinic staff, their role, and verify qualifications if needed (i.e., appropriate licensure for vaccinator, background checks)

▪ Ensure clinic staff understand reporting structure for their role

▪ Discuss the escalation process

❑ Review expectations of the day's caregiver volumes and any unique considerations

❑ Share location of resources and roles and responsibilities

❑ Facilitate just-in-time training for clinic staff new to their role

❑ Discuss how breaks and lunch will work

Operations Lead Checklist

1.Vaccination Area Set up•Ensure Each station has necessary supplies (alcohol swabs, Band-Aids, cotton balls, gloves, Purell, sharps container, pens, document basket, station number)•Keep an inventory of extra supplies and ensure back up of each of the above supply available•Stations are set up and ready with “Need Vaccine” sign•Vaccination cards available (Distribute with vaccines)•V-Safe Information, Second dose

2.Orientation of vaccinators•Quick review of IM injections (no aspiration), gloves not required, safety needles, sharps container•Overview of Station equipment (Purell between injections)•Review CDC Covid vaccination guidelines•Vaccinator role with vaccination card (sign the card, ensure sticker and return date is on card, remind caregivers to bring card for second dose)•Encourage scanning of V-Safe Information Form with QR Code•Privacy Station•Review breaks

3.Observation Area Orientation with EMS and RNs•Vitals machine•Epinephrine IM for anaphylaxis

4.Orientation of RN Observers / Safety Monitors•Review code safety equipment•General flow of the observation area•Emergency workflow with AMR/EMS•Workflow review for anaphylaxis when AMR/EMS is off site

5.Resource Nurse•Go over each station (vaccination station, observer area flow and equipment/ Observer role, supply area, forms)•Provide breaks to the vaccination station and observers•Supply management assistance

6.Resources For the Lead•Facilities Phone list of important numbers

7.Roles for Vaccination Clinic•Role descriptions of all roles (pre-reg, registration, clinical flex, troubleshooting, vaccinator, observation, resource nurse)

8.Forms (Awareness)•Extra copies of forms in case copies are needed urgently•Overview of the forms used (vaccination cards, Vaccination Demographic intake form)•Vaccine emergency use Authorization Code for Moderna AND Pfizer

9.Vaccine•General awareness about vaccines/expiration help pharmacy as needed

10. Inventory Control• Ensure that par levels are maintained

Clinical Operations

Director

Arrival-Registration

Registration-Vaccination-Depart

Alibi Workflow

Alibis are defined as allowing those without an appointment to walk-in and receive a vaccine.

Alibi Process

• Clinical Operations Director and Pharmacist together decide on how many walk-ins or Alibi slots will be allowed for the day.

• Clinical Operations Director will notify both the Non-Clinical Supervisor and the Registration Lead.

• All walk-ins are sent to the trouble-shooting area of patient registration.

• Attempt to reschedule appointment for another day.

• Under the discretion of the Registration Lead an Alibi slot may be given.

• Registration Lead will notify the Non-Clinical Supervisor and the Clinical Operations Director in the final hour of the clinic, how many Alibi’s were given for the day.

Vaccine for Volunteers Workflow

SU/Swedish Clinic is committed to offering vaccines to all volunteers would like to receive a vaccine.

Process

• During initial volunteer check-in, volunteer registration will ask volunteers if they would like to receive their vaccine

• Volunteers who would like their vaccine are then given a QRC to scan and fill out information

• Their information will be documented on separate Solv appointment list

• The volunteer will be given a DOH form without the lot number sticker

• When the volunteer is pulled by their lead to obtain their vaccine, they will immediately go to the troubleshooting area in patient registration

• The Registration Lead or delegate will then ensure the volunteer has an appointment (or puts one in for them)

• A Lot sticker is placed on the DOH form

• The volunteer is then to go to the front of the vaccine line to obtain their vaccine in a timely manner

• The volunteer moves to observation and returns to duties once observation period is completed.

End of Clinic Vaccine Count Workflow

SU/Swedish Clinic is committed to not wasting a single dose of vaccine

Process

• During clinic ramp down (last 45-60 minutes), Non-Clinical Supervisor allocates resources to obtain exact count of patients in line outside and inside the clinic

• One counts outside patient volume, one counts inside patient volume

• Total patient count given to Clinical Operation Director every 10 minutes

• Clinical Operations Director communicates count to Pharmacy Lead and Vaccinator Lead every 10 minutes

• Once count reaches 50:

• 1/3 of vaccinator stations close

• Vaccine preparation maintainins no fewer than 30 drawn doses

• Once count reaches 25:

• 1/3 of vaccinator stations close

• Vaccine prepareation maintains no fewer than 10 drawn doses

• One vaccinator (from closed station) to collect all doses from open vaccinator stations

• Vaccinator allocates one dose per patient, maintaining continuous count of vaccines on hand

• Clinical Operations Director maintains communication between vaccinator allocating doses and Pharmacy Lead until all doses are accounted for and given

Pathway: Washington State Patrol Identification and Criminal History Request

Pathway: Volunteer Needle stick injury

Needle Stick Injury

Triage Volunteer. Clean area and ensure volunteer is ok

Notify Clinical Operation Director

Clean Send Volunteer back to station

Used Do we know source?

No

Send the volunteer to the First Hill Emergency Dept via LYFT

Call the FH ED to alert

Yes

Call IP 206-386-2054 to notify of needle stick and provide

further details. AFTER 1600: 206-386-6000 and ask for the

Infection Prevention Call

Send both the Source and Exposed to First Hill Emergency

Dept via LYFT

SMC workflow

Fill out MS FORMS for exposure using link or QRC

Seattle University Employee or Student

Notify [email protected] Risk

Management at SU 206-296-5911

LYFT Code: PokeSMC

http://swedishonline.swedish.org/Departments/EH/employeehealth/Documents/SMG BBPE Binder.pdf

https://forms.office.com/Pages/ResponsePage.aspx?id=hpAxLiaao0aGX2Fb7VdnhiQaRKjiIz5HpysFmyn0dYlUNUxVUkRPUTg2SFhVVFAyWEs4VllSREs2MSQlQCN0PWcu

mailto:[email protected]

Pathway: WA IIS Troubleshooting

Refer to WA IIS Workflow Document

If problem is listed in the workflow

document Follow the workflow

If problem is NOT listed in workflow

1. Call for WA IIS Troubleshooter

2. Escalate to WA IIS lead

If Problem not solved: Place DOH Document in WA IIS PROBLEM

ENVELOPE

WA IIS Lead to collect all problems at the end

of clinic and escalate as needed to DOH

Contact Tracing

Pathway: Community Partners with Children

Patient/Community Partner with

Children

If 2 parents/adults

Leave child(ren) with one adult

Vaccinate one parent/adult at a

time

Only one adult and child(ren)

Reschedule if possible

Escort entire family back to the privacy

area

Obtain emergency contact information

Recover in EMS station away from

others

Supplies

DocumentsDocument PAR Level Order Volume Purpose & Location

EUA / Fact Sheet:

• Pfizer• Moderna

Pfizer – 5000Moderna – 20,000Translated – 10 of each

*Order each Wednesday with Kristen Shannon

Current on hand:

__________________

Order:

__________________

English language and translated versions accessible to all patients

• Provided at time of appointment creation, if possible.

• Available at clinic.

• Offer electronically via QR code as well as printed in all appropriate languages.

Vaccine exclusion criteria signage

Signage - Print as needed

Detailed – 30 in protective sleeves

Two locations:1. Signage at clinic containing abridged content2. Detailed content with each vaccinator

• Used to question if patient currently has a condition that would preclude them from receiving the vaccine

• Example in addenda

Department of Health Intake Form

Par = 20, 000


Current on hand:

__________________

Order:

__________________

One form for each patient

• Vital patient data for DOH

• Consent may also be obtained on this form

• Example in addenda

CDC Vaccination Record Card

Par = 500 (in addition to 1 card per dose provided with vaccine)


Current on hand:

__________________

Order:

__________________

One card for each patient

• Completed by vaccinator at time of vaccination

• Kept by patient with instruction to bring to second dose appointment

• Contains vaccine reference information for patient

https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine

https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/moderna-covid-19-vaccine?fbclid=IwAR0LNSQsnXw4iPpAwnBq6tHxM5poDyy8GOAdLv8SjYb_DmB4XNwdE-apF5Y


What to Expect After Getting a COVID-19 Vaccine• Spanish translated

Par = 20, 000Spanish Par = 1,000


Current on hand:

__________________

Order:

__________________

One handout for each patient

• Provided to patient immediately after vaccination

• Encourage use of V-Safe (website on handout)

• Additional V-Safe signage may be helpful

Documentation of adverse reaction to COVID-19 Vaccine

Par = 100


Current on hand:

__________________

Order:

__________________

Approximately 2% of total doses planned

• May be collected electronically

Washington State Patrol Identification and Criminal History Request

Par = 2,000


Current on hand:

__________________

Order:

__________________

1 per volunteer • Completed for volunteers who likely do not have background checks completed as part of their employment

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/pdfs/321466-A_FS_What_Expect_COVID-19_Vax_Final_12.13.20.pdf

https://www.cdc.gov/coronavirus/2019-ncov/downloads/vaccines/What_Expect_Vaccination_ES.pdf

https://providence4.sharepoint.com/sites/COVIDVaccinationClinic/Shared Documents/Forms/AllItems.aspx?id=/sites/COVIDVaccinationClinic/Shared%20Documents/Clinic%20Operations%20Resources/v-safe-information-sheet_709444_7.pdf&parent=/sites/COVIDVaccinationClinic/Shared%20Documents/Clinic%20Operations%20Resources


Job Aids Par = 20 per role in protective sleeves

Current on hand:

__________________

Order:

__________________

1 per volunteer; collect and re-use

• Detailed information to ensure best practice is followed in volunteer role

• Examples in addenda

MEDICAL SUPPLIES

Supplies PAR Responsible Parties

Vaccine, syringes, needles Vaccine Kits Pharmacy – Jim Lacy

Labels: Lot, next dose, exp Each Day Pharmacy

Sharps Containers 100 Swedish - MSC

Hand Sanitizer pumps 50 Swedish – MSC

Hand Sanitizer stand up refill 6 Swedish – MSC

Masks 3 cases Swedish – MSC

Goggles 250 Swedish – MSC

Sani Wipes (Purple) 20 Swedish – MSC

Band-Aids 20, 000 Swedish – MSC

Gauze 2x2 3,000 Swedish – MSC

Thermometers 6 Swedish – MSC

Alcohol Swaps 20, 000 Swedish – MSC

Cotton Balls 10 packs Swedish – MSC

OFFICE SUPPLIES

Supplies PAR Responsible Parties

Pens 200 Swedish – Kristen Shannon

Red and Blue Sharpies 50 each Swedish – Kristen Shannon

Post-it Notes 20 Swedish – Kristen Shannon

Staplers 10 Swedish – Kristen Shannon

Staples 10,000 Swedish – Kristen Shannon

Painter’s Tape (Blue) 2 roles Swedish – Kristen Shannon

N95 Guidelines

Presenting

Michael “Mike” Myint, MD, MBA | Physician Executive Population Health

MultiCare Connected Care | MultiCare

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/820-117-N95PrioritizationInpatientHospitals.pdf

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/820-117-N95PrioritizationInpatientHospitals.pdf

Workgroup created in response to Joint Hazard Alert• DOH (facilitator)• Governor’s Office• Labor and Industries• Nursing Unions• Local Public Health• WSHA—Mike Myint, John Lynch & Darcy Jaffe

Decision to use N-95s in contingency or crisis usage is based on assumptions that:

• Facilities understand their NIOSH-approved respirator inventory and supply chain.

• Facilities understand their NIOSH-approved respirator utilization rate.

• Facilities are in communication with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional supplies.

• Facilities have already implemented other engineering and administrative control measures

• Facilities have provided HCP with required education and training, including having them demonstrate competency with donning and doffing, with any PPE ensemble that is used to perform job responsibilities, such as provision of patient care.

Capacity Management Within Categories

1 The priority for this category depends on community transmission rates. Consider raising the priority of respirator allocation to this category in the setting of widespread community transmission.

*High Priority activities include open suctioning of airways, sputum induction, CPR, intubation, extubation, Bronchosopy, O2 delivery >10 L/min

**Medium Priority activities include procedures with long exposure to head or neck, endoscopy, maternal labor stage 2, NG tube placement

COVID Vaccine Update

January 19, 2021

Washington State Department of Health | 93

Getting to 45K doses a day - short-term goal (60 days)

Photo credit: Seattle Times 1/14/2021: Randall Thomas, 71, took this photo as he waited in line for a coronavirus vaccination on Thursday in Sequim, only to be turned away just 10 cars from... (Courtesy of Randall Thomas)

70% of eligible population – 4.3 million population over 7 months / desire for faster


COVID-19 Vaccine Cumulative Doses Administered


Provider Enrollment Snapshot


Washington Plan for Increased Vaccinations

Traditional Delivery Systems

1. Healthcare system (hospitals and clinics)

2. Pharmacies

3. Workplace clinics

Enhanced Delivery Systems:

1. Local jurisdiction operation high volume community vaccination sites

2. Mobile vaccination teams

3. Community-based pop-up clinics

Mass Vaccination Delivery Systems (state-supported):

o High through-put mass vaccination sites

o Mobile vaccination teams

Note: Vaccine Supply Constraints Remain


Getting People Vaccinated

Comparison: Yearly Flu Vaccine

o 56.3% of WA population aged 6 months+ vaccinated in 2019-2020 season

oMost vaccine given Sept – March (7 months)

o Places of vaccination (2014-2015 WA data for 18 years and older, N=4636)■ Medical setting: 53.5%

♦ Doctor’s office is the most common medical setting

■ Nonmedical settings: 46.5%

♦ Most Common non-medical settings

♦ Pharmacy/store: 25.3%

♦ Workplace: 17%

♦ Other less common non-medical settings (senior centers, community events, school or college)


WA Vaccine Allocations Week # Vaccine ships

week of# Pfizer

1st doses# Pfizer

2nd doses# Moderna1st doses

# Moderna2nd doses

# sites in counties*

1 December 14 62,400 -- -- -- 41

2 December 21 44,850 -- 128,000 -- 222

3 December 28 57,525 -- 44,300 -- 86

4 January 4 57,525** 62,400 44,100 -- 135

5 January 11 44,850 34,125 44,300 -- 142

6 January 18 46,800 14,625 46,500 128,000 TBD

7 January 25 TBD 14,625 TBD 44,300 TBD

*LTCF Pharmacy, Tribes, and Urban Indian Health Program sites not included**Includes 12,675 doses advanced from CDC/OWS reserve

Weeks 3-5, over 42,900+ Pfizer doses were set aside each week for LTCF commitments

• State receives weekly vaccine allocation on Tuesdays and places orders by Thursday.

• We will have more overall vaccine doses week 6. Vaccine requests remains much greater than supply.


• Washington state has moved to Phase 1B-Tier 1 as of January 18, 2021

• Phase 1A is not finished and should still be prioritized

• Phase 1B-Tier 1 is over 1 million people and we are receiving approximately 100,000 new first doses/week so patience is needed

• Individuals can visit Phase Finder (www.findyourphasewa.org) to assess and confirm eligibility – if confirmed eligible, a link provides a list of potential provider sites

• Entering information in Phase Finder also helps us identify people live who are eligible and interested in vaccine to support our planning efforts

• We will assess moving to future phases when we cover the majority of the prioritized population

Washington State COVID-19 Vaccine Allocation Phasing

http://www.findyourphase.org/

PHASE 1A PHASE 2* PHASE 3* PHASE 4*

TIER 1

• High-risk workers in health care settings• High-risk first responders• Long-term care facility residents

TIER 2

• All other workers at risk in health care settings

• Critical workers in other settings who are in industries essential to the functioning of society and are at risk of exposure not already covered in Phase 1

• People 16 years and older with 1 comorbidity or underlying condition not already covered in Phase 1

• People with disabilities that prevent them from adopting protective measures

• Workers in industries and occupations essential to the functioning of society and at increased risk of exposure not included in Phase 1 or 2

• Young adults/children under 16 years (if vaccine is authorized for children under 16 years)

• Everyone residing in Washington State who did not have access to vaccine in previous phases

PHASE 1B

TIER 1

• All people 65 years and older• People 50 years and older living in multigenerational

households

TIER 2

• High-risk critical workers 50 years and older who work in certain congregate settings:

• Agriculture; food processing; grocery stores; K-12 (teachers and school staff); childcare; corrections, prisons, jails, or detention facilities; public transit; fire; law enforcement

TIER 3

• People 16 years and older with 2 or more comorbidities or underlying conditions

TIER 4

• High-risk critical workers under 50 years who work in certain congregate settings (as noted above in Tier 2)

• People, staff, and volunteers in congregate living settings:• Correctional facilities; group homes for people with

disabilities; people experiencing homelessness that live in or access services in congregate settings

EQUITY IS A CROSS-CUTTING FOCUSUpdated January 17, 2020

*Future phases are still tentative and will be finalized based on clinical trial data, federal guidance, vaccine supply projections, and ongoing community input.

Certain population groups have been prioritized with an aim to mitigate health inequities recognizing that specific populations are disproportionately impacted by COVID-19 due to external social factors and systemic inequities. Examples of populations disproportionately affected due to such factors include:

● People of color

● People with limited English proficiency

● People in shared housing, crowded housing, and multi-generational homes

● People in poverty and low-wage earners

● People with disabilities that are connected to underlying health conditions that may put a person at higher risk for COVID-19

● People with access barriers to healthcare

Washington State has also developed a social vulnerability index which includes social determinants of health factors to identify highest vulnerability areas. This will be one of several inputs informing vaccine allocation decisions to ensure equitable allocation.

NOTE Immigration status and health insurance status do not impact an individual’s eligibility.

WA Interim COVID-19 Vaccine Allocation Framework

https://fortress.wa.gov/doh/wtn/WTNIBL/


Tier 1

• High-risk workers in health care settings

• High-risk first responders

• Residents and staff of nursing homes, assisted living facilities, and other community-based, congregate living settings where most individuals over 65 years of age are receiving care, supervision, or assistance

Tier 2

• All other at-risk workers in health care settings

• Workers who are at risk of acquisition or transmission of COVID because they are interacting in close proximity (less than 6 feet) with patients, co-workers, or specimens and are unable to remain socially distant (i.e., not include remote workers)

• Healthcare settings as defined by CDC refers to places where healthcare is delivered and includes, but is not limited to, acute care facilities, long term acute care facilities, inpatient rehabilitation facilities, nursing homes and assisted living facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, and others

Phase 1a Guidance

https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/appendix/terminology.html


Tier 1

• All people 65 years and older

• People 50 years and older living in multigenerational homes

Individuals are eligible if they are at risk either dueo Vulnerability - specifically, an older adult or elder who cannot live independently and is being

cared for by a relative or in-home caregiver or being cared for by someone who works outside the home

o Risk of exposure - specifically, an older adult or elder who is living with and taking care of kinship (along the lines of a grandparent with a grandchild)

o This group does not include an older adult who is able to live independently and is taking care of the individual’s kinship/children

Phase 1b Guidance – Tier 1

Ph 1a

Dec Jan Feb Mar Apr May June July

Ph 1b-1

Ph 1b-2

Ph 1b-3

Ph 2

Ph 1b-4

Ph 3

Ph 4

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37Phase Size estimate (sizes not overlapping and assumes 100% vaccine adoption)

1a 850,000

1b-1 1,484,000

1b-2 95,000

1b-3 1,100,000

1b-4 370,000

2 1,620,000

3 2,000,000

4 200,000

Some 1b-4 populations may be vaccinated with 1b-2 for implementation feasibility

Updated 1/18/21

Second doses - allocations

45k/day target inclusive first and second doses

First doses -allocations

Second doses – projections

First doses -projections

WA State COVID-19 Best Guess Supply & Phase Projections


The state is currently in phase 1b of vaccine distribution.

• Summary guidance for Phases 1A and 1B (PDF) Updated January 18, 2021

• This visual timeline (PDF) shows phase 1a and phase 1b and the estimated dates for each

• Washington state's interim vaccine allocation and prioritization guidance (PDF) Updated January 18, 202

• Send feedback about the guidance

Website: https://www.doh.wa.gov/Emergencies/COVID19/Vaccine

Washington State COVID-19 Vaccine Allocation Guidance Resources

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/SummaryInterimVaccineAllocationPriortization-1-18-21.pdf

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/VaccinationPhasesInfographic-1-18-21.pdf

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/820-112-InterimVaccineAllocationPrioritization-1-18-21.pdf

https://fortress.wa.gov/doh/opinio/s?s=WACOVIDVaxAllocation

https://www.doh.wa.gov/Emergencies/COVID19/Vaccine

Washington State Department of Health |

Promoting Phase Finder

• Early January: Soft launch began

• January 13: Launched initial social and radio ads targeting healthcare workers

• January 18: Launch TV, radio, digital and social media ads (in English and

Spanish)

• Skews to reaching adults 50+ for two weeks

• Will expand reach and adjust targeting as phases progress

• In-language social and banner ads will roll out as tool is complete in

those languages

• Ongoing: Healthcare provider and vaccine administrator outreach

• Notified to expect the tool’s eligibility form

• Encouraged to direct people to Phase Finder to determine eligibility

Washington State Department of Health |

Eligibility Screen


Beginning Friday, January 22nd, COVID-19 vaccine providers eligible to receive vaccine will begin using the Immunization Information System (IIS) to place vaccine orders for your facility. • This process is in addition to the weekly REDCap survey. • COVID vaccine ordering will be open in the IIS each weekend from

Friday 5:00pm through Monday 5:00pm. • Providers should request the number of doses they can administered

in a 7-day timeframe. • Tuesday DOH will review all COVID vaccine requests received and

any adjustments or reductions will be made to fit within our allocated amounts each week.

• Approved provider orders will be submitted to CDC by Thursday morning and vaccine will arrive the following Monday or Tuesday.

COVID-19 Vaccine Ordering Update

WA State DOH | 108

COVID-19 Vaccine Transfers

• Vaccine transfers must be accounted for in the Immunization Information System (IIS)

• Please enter your transfer request in the IIS 24 hours prior to needing to conduct the transfer to allow time for the program to review, asking any follow-up question and approve the transfer request

• If you do not see the “Create Transfer” button on your Create/View order page, please notify the program at [email protected] with your PIN number if known

• Reminder: Providers must have an approved redistribution agreement on-file with the program prior to transferring vaccine


https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/348-777-CDC-COVIDRedistributionAgreementandChecklist.pdf

WA State DOH | 109

Resources for Managing COVID Vaccine in the IIS

Vaccine Ordering Inventory Management

• Guide: Vaccine Ordering & Receiving

• Video: Vaccine Ordering

• Video: Vaccine Receiving

• Guide: Vaccine Transferring

• Video: Vaccine Transferring

• Guide: How to Search, Add, Reconcile and Report Inventory

• Guide: Managing Inventory with an Interface

• Guide: Troubleshooting Inventory with the Patient Detail Report

Additional resources available: • COVID-19 Vaccine Provider Toolkit and Resources• IIS Training Materials Portal and YouTube channel

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-351-CreateSubmitVaccineOrder.pdf

https://www.youtube.com/watch?v=XNfgezFWQrk&list=PL82Z-swK0-4lKe1hI3spRI6vFY6nCq5iK&index=1

https://www.youtube.com/watch?v=ZyKKh95OZ9w&list=PL82Z-swK0-4lKe1hI3spRI6vFY6nCq5iK&index=2

https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/348-781-COVIDTransferRequestProcessinIIS.pdf

https://www.youtube.com/watch?v=dGGj5Kgm7do&feature=youtu.be

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-648-SearchAddAdjustReportReconcileInventory.pdf

https://www.doh.wa.gov/Portals/1/Documents/8200/348-610-ManagingInventoryWithInterface.pdf

https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-527-QuickReferencePatientDetailReport.pdf

https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/VaccineInformationforHealthcareProviders/ToolkitandResources

https://www.youtube.com/playlist?list=PL82Z-swK0-4lKe1hI3spRI6vFY6nCq5iK


COVID Vaccine Email

■[email protected]

COVID-19 Vaccine Partner Calls

■1st & 3rd Tuesday of the month 9 AM- 10:30 AM

COVID-19 Vaccine Distribution list

■Email COVID vaccine email to be added

Communication & Updates


To request this document in another format, call 1-800-525-0127. Deaf or hard ofhearing customers, please call 711 (Washington Relay) or email [email protected].