Vaccine Distribution 4/3/2014 LEARNING OBJECTIVES PHARMACY TECHNICIAN CAREERS PRE-TEST INTRODUCTIONS

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1 LEARNING OBJECTIVES PHARMACY TECHNICIAN CAREERS Define the special responsibilities of an ordering/inventory technician. Define the special responsibilities of a technician supervisor. Outline activities of a pharmacy technician specializing in medication safety. Outline activities of a pharmacy technician specializing in computer systems. List some of the unique challenges in maintaining vaccine inventory. PRE-TEST T or F Medication safety means being alert for situations that could possibly result in patient harm. T or F Ordering and inventory management are tasks that can be easily done as part of a technician s other duties. T or F A technician supervisor may conduct technician performance reviews. T or F Vaccines often have strict storage requirements and require temperature monitoring. T or F Hospital pharmacy technicians typically may edit any part of a patient s electronic health record. INTRODUCTIONS Kathy Crowther moderator Kamarra Fauese medication safety Tommie Belanger computer systems Valerie Card-King ordering/inventory Debbie Tobuk vaccine inventory and distribution Maria Terch pharmacy technician supervisor dltobuk@scf.cc Vaccine Distribution Debra Tobuk-CPhT TechnicianSupervisor PCC Pharmacy 4320 Diplomacy Dr.Suite 1203 Anchorage, Ak (907) Vaccines monthly par level amounts VACCINES NDC Doses/Supplier 1)DT(Pediatric)/Sanofi Pasteur state case to case 2)DTaP(Infanrix)/GSK /State 3)DTaP-HepB-IPV (Pediarix)/GSK /State 4)DTaP-IPV (Kinrix)/ GSK /State 5)Hep A(Havrix) PEDS/GSK /State 6)Hep B(Recombivax-HB) PEDS/Merck /State 7)Hib(PEDVAX HIB) PEDS/Merck /State 8)HPV(Gardasil)/Merck /State 20/McKesson-/*Merck 9)IPV(Polio Vaccine) IPOL/Sanofi Pasteur /State 10)Meningococcal(Menactra)/SanofiPasteur /State-10/McKesson 11)MMR(Measle,Mump,Rubela)/Merck /State-20/McKesson 12)PCV713(Prevnar)/Pfizer /State 13)PPD TB Skin test/sanofi Pasteur /State every 3 months 14)PPSV23(Pneumovax23)/Merck /State-430/McKesson 15)Rotavirus(Rotateq)/Merck /State 16)TD(Adult Tenivac)/Sanofi Pasteur /State-40/McKesson 17)Tdap(Boostrix)/GSK /State /McKesson 18)Varicella(Varivax[Peds])/Merck /State-20/McKesson 19)Hep A(Havrix 1440ELU [Adult])/GSK /McKesson 20)Hep B(Engerix [Adult])/GSK (CAMPUS WIDE)/McKesson 21)Zoster(Zostavax[Adult]) PCC/10 VNPCC McKesson 1)Flumist Quadrivalent (2-49) PFS Nasal Spray 2)FluLaval (Adult/3 & up) MD vial 3)Fluzone (Peds 6-36 mos.) PFS 4)Fluzone (3 & up) PFS 5)Fluzone High Dose (65 & up) PFS 1

2 Storage temperatures: Refrigerator temperature range: 2.2 C (36 F) and 7.7 C (46 F) Room temperature range: 15 C (59 F) to 30 C (86 F) Freezer temperature range: -15 C (5 F) or colder Purchased = X Clinic Storage VACCINES NDC MIN FM MAX FM Min Max Min Peds Max Peds Max in Peds X fridge PURCHASED = X DTaP(Infanrix) NO YES DTaP-IPV (Kinrix) NO YES DTaP-HepB-IPV (Pediarix) NO YES Hepatitis A(Havrix) PEDS NO YES Hep B(Recombivax-HB) PEDS NO YES Hib(PedvaxHIB)PEDS NO YES HPV(Gardasil) YES YES IPV-Polio (IPOL) YES YES Meningococcal(Menactra) YES YES Measles,Mumps,Rubella(MMR) YES YES PCV13 (Prevnar) YES YES PPD Tuberculin(Tubersol) YES NO PPSV23(Pneumovax23) YES YES Rotavirus(Rotateq) YES YES TD(Adult) YES YES Tdap(Boostrix) YES YES Varicella(Freezer) YES YES Hepatitis B(Engerix) Adult YES NO INFLUENZA NDC Peds Max FM MAX VCF MAX IM Purchased VCF Flumist (2-49yr) IntraNasal YES = X YES Fluarix Quad (3yr+) PF syringe NO YES Fluzone (6-35months) PF syringe YES = X YES Fluzone (36months+)PF syringe YES = X No Flulaval (18yr+) MDV YES = X NO Temperature Monitoring Device 2

3 Log tag in glycol solution Twice-a-day checks Warning sign Fridge/Freezer with Warning sign On circuit breakers Emergency/power outage plan for vaccines D Until prepared to pack and move vaccines, KEEP ALL REFRIGERATOR/FREEZER DOORS CLOSE The temperature monitor must stay with the vaccines AT ALL TIMES As appropriate for your facility, include name and phone numbers of emergency contacts below Facility Primary Vaccine Coordinator: Home Phone: Cell: Facility Secondary Vaccine Coordinator: Home Phone: Cell: Building Maintenance: Phone: Electric Company: Phone: Alarm Monitoring Company: Phone: Alternate Storage Facility: Contact Name: Phone: (day) (night) RefrigeratorRepair Company: Phone: 3

4 Emergency procedure to protect vaccines Activate generator if used for alternate source of power Check circuit breakers (Specify location) Contact primary or secondary vaccine coordinator at your facility and alternate storag e facility to confirm arrangements (see names above) Prior to transport of vaccines, record time and refrigerator(s)and freezer(s) temperatu res Do not open the refrigeratorand/or freezer doors until preparations are complete for packing and moving the vaccine to the alternate storage unit or facility Begin process to transfer vaccines while maintaining cold chain procedures for storage and handling. See pages 2-4 for instructions and diagrams (Specify alternate storage location) Keep calibrated state-supplied Data Logger temperature monitor(s) with vaccines Place backup temperature monitor in storage unit to determine when it is safe to move vaccines back Varicella vaccines (from freezer) must be kept frozen PRE-EVENT Identify location of essential materials for temporary vaccine storage or transport Insulated coolers (2 or more) Cool packs (4 or more) Ice packs (4 or more) Portable freezer and/or original Varicella shipping container with original ice packs for transporting Varicella vaccine Thermometers (move with vaccines) Packing materials Flashlights (should be readily available) Spare batteries Other (as needed for your facility) TRANSPORT OF REFRIGERATED VACCINES (DO NOT FREEZE) Pack the refrigerated vaccines first, using enough refrigerated/frozen packs to maintain the cold chain. Include the state-supplied calibrated temperature monitoring device with the vaccines Keep vaccines in original boxes Document the time and temperature of the vaccine storage unit as the vaccine is removed for transport Pack an insulated cooler according to protocol with calibrated temperature monitors Place an insulating barrier (e.g., bubble wrap, crumpled brown packing paper, Styrofoam peanuts) between the frozen packs and the refrigerated packs. The Vaccines should have the cold pack and the insulating barrier protecting it from the ice packs to prevent the vaccine from freezing. The contents of the container should be layered as follows: frozen packs, insulating barrier (to minimize risk of freezing), refrigerated packs, a cardboard barrier, vaccine, a temperature monitor, another layer of barrier material, and additional refrigerated or frozen packs. The barrier surrounding the vaccine and monitor could be a cardboard box An unpackaged individual vial/syringe/oral dose should never be in direct contact with the refrigerated or frozen packs! A manufacture vaccine package should never be in direct contact with frozen packs! Use properly placed temperature monitors near the vaccine to assess whether the cold chain has been maintained. The temperature monitors should be placed next to the vaccine and should not come in contact with the refrigerated or frozen packs Label the outside of the container(s) to identify the contents as fragile vaccines requiring refrigeration (see below for further details on frozen vaccines) Cold Storage Transport of frozen vaccines Pack the frozen vaccines last along with the state-supplied calibrated temperature monitoring device in a separate insulated container. A portable freezer is preferred. Follow the manufacture instructions for use. If a portable freezer is unavailable or unprepared at the time of transport, you may also use the original Varicella shipping container with the specialized frozen packs. The original shipping frozen packs from these boxes should be kept frozen in the freezer for emergency transportation. Place the Varicella vaccine and calibrated temperature monitor in the shipping container and wrap the frozen packs around the boxed vaccines Keep vials in original manufacture packaging. Document the time and the temperature of the storage unit as the vaccine is removed for transport Label the outside of the container(s) to clearly identify the contents as frozen vaccines and with clear instructions to keep frozen Post-event Store vaccines maintaining the cold chain. Segregate the affected vaccines and mark them as Do Not Use until the vaccine viability can be determined Place Varicella vaccine immediately into a freezer even if the temperature was not maintained 5 F or less during transport. Segregate the affected Varicella and mark them as Do Not Use until the vaccine viability can be determined Do not discard vaccines Download the graph from the temperature monitor that accompanied the vaccines Complete the Vaccine Facility Incident Report form and FAX to the Epidemiology Vaccine Depot at (907) or to vaccinedepot@alaska.gov along with the downloaded temperature graph. In the report, include the minimum/maximum temperatures, incident length of time, cause of cold chain breach and/or necessity to transport Call the Epidemiology Vaccine Depot at (907) to determine vaccine viability and if further action is needed If instructed to return vaccines, include a copy of the Vaccine Return form in the box Review and update your Emergency Plan once a year and during staff turnover. Write Revision date at top of first page. 4

5 POST-TEST Topics for group discussion: What are some good traits to possess if you wish to advance your pharmacy tech career? Why are there so few opportunities for technician advancement? How can we promote pharmacy technician advancement? What are some of the upcoming changes in pharmacy that will affect technician careers? 5