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Essential Policies & Procedures:
Vaccine Procurement, Storage,
and Administration
March 17, 2020
Continuing Education Credits
In support of improving patient care, Community Health Center,
Inc./Weitzman Institute is jointly accredited by the Accreditation Council
for Continuing Medical Education (ACCME), the Accreditation Council for
Pharmacy Education (ACPE), and the American Nurses Credentialing
Center (ANCC), to provide continuing education for the healthcare team.
This designation confers simultaneous continuing education
accreditation across nine national accrediting bodies.
This series is intended for physicians, nurse practitioners, nurses,
physician assistants, psychologists, clinical social workers, dentists,
pharmacists, and dietitians.
Please complete the survey – linked in the chat, and emailed to all
attendees – to request your continuing education credit for live viewing.
A comprehensive certificate will be sent out at the end of the series.
This week’s COVID-19 ECHO session
is a collaboration with
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant
number U30CS29049 entitled "Training and Technical Assistance National Cooperative Agreements (NCAs)" for grant amount $2,045,000 with 0% financed with
non-governmental funds. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor
should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Disclosure
• With respect to the following presentation, there has been no relevant
(direct or indirect) financial relationship between the parties listed above
(or spouse/partner) and any for-profit company in the past 12 months
which would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenter and
may not reflect official policy of Community Health Center, Inc. and its
Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled,
experimental, and/or under investigation (not FDA approved) and any
limitations on the information hat I present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or
unsupported opinion.
COVID-19 Update in the United States
March 17, 2021
Stephen Scholand, MD
Infectious Disease Specialist, Midstate Medical Center
29,544,991 cases on 3/16/21 with 536,808 deaths
https://coronavirus.jhu.edu/us-map
COVID-19 in the United States
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Different
slope of
decline
How Many ‘Jet Liners’? A320 seats 182 passengers
Pressure on Hospital Systems
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
The Danger of Variants
• B.1.1.7 is more transmissible and more
deadly than other variants
• 55% higher risk of dying within 28 days of
being tested positive for Covid-19
• Known to be substantially more
transmissible than other SARS-CoV2
Coronavirus lineages
• Covid-19 vaccines appear to be highly
effective against the B.1.1.7 variant
Davies, N.G., Jarvis, C.I., CMMID COVID-19 Working Group. et al. Increased mortality in community-tested cases of
SARS-CoV-2 lineage B.1.1.7. Nature (2021). https://doi.org/10.1038/s41586-021-03426-1
The Danger of Variants
Yang Liu et al. New England Journal Neutralizing Activity of BNT162b-Elicited Serum
www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html
COVID-19 Vaccinations Across the Nation
https://covid.cdc.gov/covid-data-tracker/#vaccinations
https://covid.cdc.gov/covid-data-tracker/#vaccinations
Trusted Resources
• Nuvance health 2400+ articles reviewed:
https://spark.adobe.com/page/dkBGIBUH6QEZJ/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2021/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/
Essential Policies & Procedures:
Vaccine Procurement, Storage,
and Administration
Mary Blankson, DNP, APRN, FNP-C
Chief Nursing Officer, Community Health Center, Inc.
Natalie Bycenski, RN, MSN
Nurse Manager, Community Health Center, Inc.
Procuring the Vaccine: Process
• State Process
• HRSA Process
• Tracking Doses
– 1st Dose vs. 2nd Dose
– State vs. HRSA
– Extra Doses
– Wastage
Procuring the Vaccine: Policies
• Standard Labeling
• Scheduling 2nd Dose
Appointments
• Inventory Tracking
– Wastage
– Extra Doses
Storing the Vaccine: Process
• Diluent
– 0.9% sodium chloride: room temperature
• Vaccine Ultra-cold
– -80°C and -60°C (-112°F to -76°F) through mfg exp date
• Vaccine Dry Ice
– Replenish 10-16 mm of dry ice pellets within 24 hours of receipt of the
vaccine
– Replenish every 5 days thereafter (up to 2 times)
Pfizer
Storing the Vaccine: Process
• Vaccine Standard Freezer
– Between -25°C and -15°C (-13°F to 5°F) for up to 2 weeks
– Vials can be returned one time to ultra-cold temperatures
which will suspend the 2 week timeframe
• Vaccine Refrigerator
– Between 2⁰C and 8⁰C (36⁰F and 46⁰F) for up to 5 days
– Cannot be refrozen (protect from light)
• Vaccine Room Temp
– Up to 25⁰C (77⁰F) for 2 hours including thaw time.
– Vials must be reconstituted or returned to the refrigerator
within 2 hours (protect from light)
Pfizer
Storing the Vaccine: Process
• Vaccine Freezer
– Between -25°C and -15°C (-13°F to 5°F) through mfg exp date
• Vaccine Refrigerator
– Between 2⁰C and 8⁰C (36⁰F and 46⁰F) for up to 30 days (protect from
light)
• Vaccine Room Temperature
– Between 8⁰C and 25 ⁰ (46 ⁰F and 77 ⁰F) for up to 12 hours cumulative
(protect from light)
Moderna
Storing the Vaccine: Process
• Do Not Store Frozen
• Vaccine Refrigerator
– Between 2°C to 8°C (36°F to 46°F) (protect from light)
• Vaccine Room Temperature
– Un-punctured vials of Janssen COVID-19 Vaccine may be stored
between 9°C to 25°C (47°F to 77°F) up to 12 hours.
Janssen Johnson & Johnson
Storing the Vaccine: Policies
• Unpacking Vaccine
• Temperature Monitoring
– Remote Monitoring
– Power Outages
– Storage Unit Failures
– Temperature Excursions
• Vaccine Transports
• Vaccine Security
• Training Requirements & Competencies
Vaccine Administration: Process
• Age Approved
• Contraindications and Precautions
• Thaw Time
• Dose
– Needle Choice
– Low Dead Space vs. Other Needles
• Aseptic Technique
• Review Injection Sites
• Alternative Injections Sites
• Vaccine Trials
Vaccine Administration: Process
• Dilution
– Invert the vial 10 times (Do NOT shake)
– Using a 21G or narrower needle draw up 1.8mL of 0.9% sodium chloride diluent
into a mixing syringe
– Inject diluent into the vaccine vial and withdraw 1.8mL of air from the vaccine
vial to equalize the pressure
– Again invert the vial 10 times (Do NOT shake)
• Vaccine will be off white in color
• Keep the mixed vaccine between 2°C to 25°C (36°F to 77°F) up to 6 hrs
• 0.3mL dose IM
Pfizer
Vaccine Administration: Process
• No dilution required
• Gently swirl the vaccine (Do NOT shake)
• Vaccine will be white to off-white in color (may contain white particles)
• Once the vial has been punctured keep the vaccine between 2°C to 25°C
(36°F to 77°F) up to 6 hours
• 0.5mL dose
Moderna
Vaccine Administration: Process
• No dilution required
• Gently swirl the vaccine in an upright position for 10 seconds prior to
drawing up the dose (Do NOT shake)
• Vaccine will be colorless to slightly yellow in a clear to very opalescent
suspension
• Once the vial has been punctured
– Keep the vaccine between 2°C to 8°C (36°F to 46°F) for up to 6 hours OR…
– At room temperature (max 25°C/77°F) for up to 2 hours
• 0.5mL dose
Janssen Johnson & Johnson
Vaccine Administration: Policies
• Standing Order for Vaccine Administration
• Standing Order for Emergency Medication Administration
• PPE Policies
– Gloves: To use or not use in times of shortages?
• Blood Borne Pathogen Exposures
Managing Adverse Reactions
• Community Support
• Providers
• EMTs
• Standing Orders
• Epi Pens – 3 Minimum
Clinic-Specific Procedures
• Routine Clinics
• Mass Vaccination Clinics
• Mobile Clinics
Thank You!
To learn more about The Path Forward series
WeitzmanLearning.org/the-path-forward
To view previous COVID-19 sessions:
WeitzmanLearning.org/coronavirus

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Policies and Procedures for Vaccine Management

  • 1. Essential Policies & Procedures: Vaccine Procurement, Storage, and Administration March 17, 2020
  • 2. Continuing Education Credits In support of improving patient care, Community Health Center, Inc./Weitzman Institute is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. This designation confers simultaneous continuing education accreditation across nine national accrediting bodies. This series is intended for physicians, nurse practitioners, nurses, physician assistants, psychologists, clinical social workers, dentists, pharmacists, and dietitians. Please complete the survey – linked in the chat, and emailed to all attendees – to request your continuing education credit for live viewing. A comprehensive certificate will be sent out at the end of the series.
  • 3. This week’s COVID-19 ECHO session is a collaboration with This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U30CS29049 entitled "Training and Technical Assistance National Cooperative Agreements (NCAs)" for grant amount $2,045,000 with 0% financed with non-governmental funds. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
  • 4. Disclosure • With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the parties listed above (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. • The views expressed in this presentation are those of the presenter and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. • We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information hat I present, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.
  • 5. COVID-19 Update in the United States March 17, 2021 Stephen Scholand, MD Infectious Disease Specialist, Midstate Medical Center
  • 6. 29,544,991 cases on 3/16/21 with 536,808 deaths https://coronavirus.jhu.edu/us-map COVID-19 in the United States
  • 8. How Many ‘Jet Liners’? A320 seats 182 passengers
  • 9. Pressure on Hospital Systems https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
  • 10. The Danger of Variants • B.1.1.7 is more transmissible and more deadly than other variants • 55% higher risk of dying within 28 days of being tested positive for Covid-19 • Known to be substantially more transmissible than other SARS-CoV2 Coronavirus lineages • Covid-19 vaccines appear to be highly effective against the B.1.1.7 variant Davies, N.G., Jarvis, C.I., CMMID COVID-19 Working Group. et al. Increased mortality in community-tested cases of SARS-CoV-2 lineage B.1.1.7. Nature (2021). https://doi.org/10.1038/s41586-021-03426-1
  • 11. The Danger of Variants Yang Liu et al. New England Journal Neutralizing Activity of BNT162b-Elicited Serum
  • 13. COVID-19 Vaccinations Across the Nation https://covid.cdc.gov/covid-data-tracker/#vaccinations
  • 15. Trusted Resources • Nuvance health 2400+ articles reviewed: https://spark.adobe.com/page/dkBGIBUH6QEZJ/ • CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html https://emergency.cdc.gov/coca/calls/2021/ • WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 • Johns Hopkins: https://coronavirus.jhu.edu/map.html • Others https://www.thelancet.com/coronavirus https://covidactnow.org/
  • 16. Essential Policies & Procedures: Vaccine Procurement, Storage, and Administration Mary Blankson, DNP, APRN, FNP-C Chief Nursing Officer, Community Health Center, Inc. Natalie Bycenski, RN, MSN Nurse Manager, Community Health Center, Inc.
  • 17. Procuring the Vaccine: Process • State Process • HRSA Process • Tracking Doses – 1st Dose vs. 2nd Dose – State vs. HRSA – Extra Doses – Wastage
  • 18. Procuring the Vaccine: Policies • Standard Labeling • Scheduling 2nd Dose Appointments • Inventory Tracking – Wastage – Extra Doses
  • 19. Storing the Vaccine: Process • Diluent – 0.9% sodium chloride: room temperature • Vaccine Ultra-cold – -80°C and -60°C (-112°F to -76°F) through mfg exp date • Vaccine Dry Ice – Replenish 10-16 mm of dry ice pellets within 24 hours of receipt of the vaccine – Replenish every 5 days thereafter (up to 2 times) Pfizer
  • 20. Storing the Vaccine: Process • Vaccine Standard Freezer – Between -25°C and -15°C (-13°F to 5°F) for up to 2 weeks – Vials can be returned one time to ultra-cold temperatures which will suspend the 2 week timeframe • Vaccine Refrigerator – Between 2⁰C and 8⁰C (36⁰F and 46⁰F) for up to 5 days – Cannot be refrozen (protect from light) • Vaccine Room Temp – Up to 25⁰C (77⁰F) for 2 hours including thaw time. – Vials must be reconstituted or returned to the refrigerator within 2 hours (protect from light) Pfizer
  • 21. Storing the Vaccine: Process • Vaccine Freezer – Between -25°C and -15°C (-13°F to 5°F) through mfg exp date • Vaccine Refrigerator – Between 2⁰C and 8⁰C (36⁰F and 46⁰F) for up to 30 days (protect from light) • Vaccine Room Temperature – Between 8⁰C and 25 ⁰ (46 ⁰F and 77 ⁰F) for up to 12 hours cumulative (protect from light) Moderna
  • 22. Storing the Vaccine: Process • Do Not Store Frozen • Vaccine Refrigerator – Between 2°C to 8°C (36°F to 46°F) (protect from light) • Vaccine Room Temperature – Un-punctured vials of Janssen COVID-19 Vaccine may be stored between 9°C to 25°C (47°F to 77°F) up to 12 hours. Janssen Johnson & Johnson
  • 23. Storing the Vaccine: Policies • Unpacking Vaccine • Temperature Monitoring – Remote Monitoring – Power Outages – Storage Unit Failures – Temperature Excursions • Vaccine Transports • Vaccine Security • Training Requirements & Competencies
  • 24. Vaccine Administration: Process • Age Approved • Contraindications and Precautions • Thaw Time • Dose – Needle Choice – Low Dead Space vs. Other Needles • Aseptic Technique • Review Injection Sites • Alternative Injections Sites • Vaccine Trials
  • 25. Vaccine Administration: Process • Dilution – Invert the vial 10 times (Do NOT shake) – Using a 21G or narrower needle draw up 1.8mL of 0.9% sodium chloride diluent into a mixing syringe – Inject diluent into the vaccine vial and withdraw 1.8mL of air from the vaccine vial to equalize the pressure – Again invert the vial 10 times (Do NOT shake) • Vaccine will be off white in color • Keep the mixed vaccine between 2°C to 25°C (36°F to 77°F) up to 6 hrs • 0.3mL dose IM Pfizer
  • 26. Vaccine Administration: Process • No dilution required • Gently swirl the vaccine (Do NOT shake) • Vaccine will be white to off-white in color (may contain white particles) • Once the vial has been punctured keep the vaccine between 2°C to 25°C (36°F to 77°F) up to 6 hours • 0.5mL dose Moderna
  • 27. Vaccine Administration: Process • No dilution required • Gently swirl the vaccine in an upright position for 10 seconds prior to drawing up the dose (Do NOT shake) • Vaccine will be colorless to slightly yellow in a clear to very opalescent suspension • Once the vial has been punctured – Keep the vaccine between 2°C to 8°C (36°F to 46°F) for up to 6 hours OR… – At room temperature (max 25°C/77°F) for up to 2 hours • 0.5mL dose Janssen Johnson & Johnson
  • 28. Vaccine Administration: Policies • Standing Order for Vaccine Administration • Standing Order for Emergency Medication Administration • PPE Policies – Gloves: To use or not use in times of shortages? • Blood Borne Pathogen Exposures
  • 29. Managing Adverse Reactions • Community Support • Providers • EMTs • Standing Orders • Epi Pens – 3 Minimum
  • 30. Clinic-Specific Procedures • Routine Clinics • Mass Vaccination Clinics • Mobile Clinics
  • 31. Thank You! To learn more about The Path Forward series WeitzmanLearning.org/the-path-forward To view previous COVID-19 sessions: WeitzmanLearning.org/coronavirus