Medication management: Use updated CDC toolkit to improve staff training and management of vaccines
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September 21, 2017
Train employees how to take maximum advantage of new technologies while adhering to best practices to improve vaccine management
The CDC’s Vaccine Storage and Handling Toolkit, updated in 2016, offers guidance on a range of issues, including recommendations on staff training. The toolkit and other CDC materials are cited by The Joint Commission as go-to sources on vaccine management.
“Hospitals do a pretty good job with vaccine storing and handling. But when there is a breakdown, it usually happens in one of three elements: well-trained staff, reliable storage and accurate vaccine inventory,” says Sean Trimble, a public health analyst with the CDC.
“A well-trained staff cannot be emphasized enough, because if you have that, and then you have something fail in another area, the staff knows how to respond and how to fix it.”
Start by designating and training a primary vaccine coordinator, as well as an alternate. Provide extra training to these individuals on proper storage and handling of vaccines, including emergency policies and procedures.
Technology must complement training
There are many technologies that remove or reduce the burden of human maintenance. For example, vaccine refrigeration is easier now because of temperature monitoring systems that record and adjust temperatures automatically.
“Keeping vaccine at the proper temperature is not as complicated as it once was, now that better equipment is available as well as 24/7 temperature monitoring hardware,” says Kate Jester-Brod, vice president of customer success at EOScene Corporation, a Seattle-based health care facility management software company.
“There is a difference between having a temperature monitoring tool and having a full-blown temperature monitoring system,” notes Jester-Brod. A system that features real-time and predictive reporting can allow a hospital to “take their vaccine management to a new level, a place that promotes overall process improvement and better, safer healthcare.”
This does not mean, however, that training no longer needs to occur. Problems with training lead to problems with deficiencies.
“Users often have not had sufficient instruction on how to operate…devices,” explains John R. Rosing, executive vice president and principal of Naperville, Ill.-based Patton Healthcare Consulting.
“Another failing we often see is that staff have dutifully recorded a [vaccine refrigerator’s] temperature excursion, for example, a reading above the upper control limit range, but then failed to note what, if anything, they did about it.”
Follow local and state requirements
Check with state immunization programs and others to determine staff responsibilities that are specific to your state or region, then train accordingly.
Some CDC and local state guidelines still require providers using government-funded vaccines — and specifically the federally funded Vaccines for Children (VFC) program — to have documented, manual, twice-daily temperature log readings, points out Jester-Brod.
The CDC toolkit recommends that “all staff members who receive deliveries and/or handle or administer vaccines should be familiar with storage and handling policies and procedures at your facility.”
Keep information on standard operating procedures near vaccine storage units and make sure all relevant staff members know where to find them.
The CDC recommends offering vaccine management training at the following intervals:
- Initially, during new employee orientation.
- Annually, as a refresher for all staff involved in immunization activities.
- Whenever new vaccines are added to your inventory.
- Whenever relevant recommendations are updated.
- Record the names of training sessions along with dates and participants. Note that this is required for any VFC provider.
In addition, Trimble advises, reach across department lines to make sure policies and procedures are uniform, or at least compatible.
“Coordination and cohesion can be an issue, so make sure there is vaccine management cohesion between the different units,” Trimble says.
Various training modules are available. The CDC offers a program named “You Call the Shots,” which is available for free online. State immunization programs also have training modules available.
Editor's note: This article originally ran in Inside The Joint Commission.
Medication management: Ensure proper equipment for vaccine refrigeration, power sources
The right equipment and the right policies are equally essential for proper vaccine refrigeration, experts contend.
Ensure you have a comprehensive approach, suggests Sean Trimble, a public health analyst with the CDC, which recently updated its Vaccine Storage and Handling Toolkit to offer guidance on all aspects of vaccine management, including refrigeration.
“First, you need to have a reliable standalone or pharmaceutical-grade [storage] unit,” Trimble says. It should be a purpose-built refrigeration unit with the ability to refrigerate and freeze. “Write up your standard operating procedures including cleaning instructions and your maintenance schedule.”
The CDC’s new recommended Fahrenheit temperature range for vaccine storage is 36° F to 46° F, according to the toolkit. That is a change from the previous range of 35° F to 46° F. The Celsius temperature range (2° C to 8° C) remains unchanged.
TJC cites toolkit as guidance
In response to frequently asked questions, The Joint Commission recommends the CDC’s page on vaccines and specifically the updated toolkit as key sources for information on proper vaccine management and storage.
Among other things, Trimble and the CDC recommend regarding storage:
- If a purpose-built unit is not available, standalone, household-style refrigerators will suffice, as long as they can accommodate maximum inventory without crowding;
- Smaller, “dormitory-style” refrigerators are prohibited;
- Plug in only one storage unit per electrical outlet to avoid creating a fire hazard or triggering a safety switch that would turn off power;
- Post “do not unplug” signs to alert staff, custodians, electricians and other workers not to unplug units; and
- Do not store food and beverages alongside vaccines in refrigeration units.
To record refrigerator temperatures, use a digital data logger for each unit and at least one backup in case of a broken or malfunctioning device. Take note of how often the loggers need to be recalibrated.
“Those tend to drift over time, so it’s important to remember to calibrate every one to two years,” Trimble recommends. “If the manufacturer has different advice, follow that as well.”
The CDC does not recommend alcohol or mercury thermometers, bi-metal stem devices, food temperature monitoring devices, chart recorders, infrared temperature monitoring devices or any other temperature monitoring device that does not have a valid Certificate of Calibration Testing.
Record units twice daily on a log with the temperature, date, time and the initials of person recording the data. That should include documenting temperatures at times when a given facility may be closed, says John R. Rosing, executive vice president and principal of Patton Healthcare Consulting in Naperville, Ill.
Digital instruments can record temperature information in lieu of manual documentation, but employees must receive proper instruction beforehand, notes Rosing.
“Some [hospitals] have used an electronic ‘minimum/maximum’ digital memory thermometer that, if used correctly, would inform you on Monday morning what the lowest and highest temperature was since the memory in the device was last cleared,” Rosing explains. “But users often have not had sufficient instruction on how to operate these devices and thus fail to accurately detect or record temperature excursions that occur when the clinic is closed.”
Make training specific to equipment
Make sure vaccine training covers the specific equipment involved in refrigeration, ensuring staff members who are responsible for vaccine management understand how devices such as thermometers work and are maintained.
Provide instruction on not only the basics of things like documentation or temperature range, but also how to rectify problems when they inevitably arise.
“Another failing we often see is that staff have dutifully recorded a temperature excursion, for example, a reading above the upper control limit range, but then failed to note what, if anything, they did about it,” Rosing points out.
As such, Rosing recommends that training includes:
- That ongoing temperature monitoring of vaccine stock is critically important;
- Precise detail on how temperatures are to be read and documented;
- Actions to be taken if a temperature “excursion,” or fluctuation outside the recommended range, is observed;
- How those corrective actions are documented and monitored to verify they were effective; and
- Observing excursions and actions over time to identify patterns that signal a need to improve the process or upgrade equipment.
Back-up power required
Although a backup generator is not absolutely necessary, a backup plan is.
“An on-site generator having enough fuel for at least 72 hours can prevent you from having to move the vaccines to another location during an outage,” Trimble notes. “Whether or not you have this, you should still have an agreement in place with another backup facility that has the proper refrigeration and an on-site generator.”
On top of emergency generators and contingency locations, day-to-day vaccine refrigeration should be undertaken in a way that minimizes risk in the event of an outage.
“If emergency generator power is unavailable, recognize that the vaccines stored in an inoperable refrigerator will be more vulnerable to degradation should the temperature excursion rise above the allowable maximum,” Rosing states. “If this occurs, the inventory would need to be discarded. Depending on the risk of this occurring, organizations might choose to limit the [capacity] of vaccines being stored in a refrigerator that has no backup power.”