Digital Repository Masters Projects Spring 2023 Evidence-based Changes to Implement Vaccine Policies, Procedures, and Education in a New Vaccine Clinic Jamie Stoddard Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Stoddard, J. 2023. Evidence-based changes to implement vaccine policies, procedures, and education in a new vaccine clinic. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 WSU REPOSITORY MSN/DNP Evidence-based Changes to Implement Vaccine Policies, Procedures, and Education in a New Vaccine Clinic Project Title by Jamie Stoddard Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY April 2, 2023 Ogden, UT Date Jamie Stoddard, RN, MSN Student 4/2/2023 Student Name, Credentials Date (electronic signature) 4/5/23 MSN Project Faculty (electronic signature) Date Melissa NeVille Norton (electronic signature) Date 05/25/2023 DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. 2 Evidence-based Changes to Implement Vaccine Policies, Procedures, and Education in a New Vaccine Clinic Jamie Stoddard, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 3 Abstract A clinic was responsible for providing vaccinations to employees and the general public. However, because this is a new responsibility for the nurses working in the clinic, no processes or procedures exist. For example, the clinic has no policies or procedures for storing, handling, administering vaccines, or preparing staff for this new responsibility. It is essential to provide the team access to these resources to provide safe patient care and avoid adverse events and high medical costs. This project aimed to create policies, procedures, and education to support this change. Three themes came to light during a literature review related to avoiding medication errors, the nurse’s role in patient education and perceptions of vaccines, and following CDC recommendations to help decrease adverse events. The evidence concerning these themes found the need to create policies, procedures, and educational content regarding vaccines. Patients and staff will benefit from this project because providing education will help them fulfill their responsibilities, and having a process in place will ensure patient safety. Keywords: vaccines, education, nurse, COVID-19, medication errors, five medication rights and policies 4 Evidence-based Changes to Implement Vaccine Policies, Procedures, and Education in a New Vaccine Clinic During a typical work shift, nurses and healthcare professionals handle medications and perform procedures in high-stress environments. Unfortunately, high-stress settings can negatively affect healthcare providers (HCPs) and patients. For example, medication errors account for harm to 1.5 million people and cost $3.5 billion a year (Academy of Managed Care Pharmacy [AMCP], 2019). Additionally, in 2000, reports show 218,000 deaths were related to medication errors (AMCP, 2019). According to the Centers for Disease Control and Prevention (CDC), vaccine administration errors can lead to adverse events, patient harm, decreased immunological protection, increased healthcare costs, and reduced vaccine confidence in healthcare (2021). Several factors can contribute to medication errors, including HCPs' attitudes about reporting their medication errors, lack of patient education, lack of communication between healthcare workers and patients, distraction when preparing or administering medications, or technology misuse (Agency for Healthcare Research and Quality [AHRQ], 2021). Moreover, vaccine administration errors can occur from a lack of vaccine protocols; these include limited staff training, improper storage and handling of vaccines, and improper use of medication administration rights (CDC, 2021). Statement of Problem A new vaccine clinic in Northern Utah will provide seasonal flu vaccines (Fluxelvax) and COVID-19 vaccines (Moderna and Jansson) for employees, and the COVID-19 vaccine available to the general public. Failure to store and handle vaccines correctly is a costly mistake and a patient safety concern. Additionally, it can lead to adverse events, double vaccination, and 5 a lack of vaccine confidence in HCPs. Nurses must stay updated on the latest information concerning COVID-19 vaccines as recommendations for boosters frequently change along with the vaccine manufacturer and doses (CDC, 2022b). The administration of COVID-19 vaccines happens in different phases based on first and second dosing and boosters. Each vaccine has various labels and dosage amounts (CDC, 2022a). Because of the complexity, it makes it vital that nurses have up-to-date knowledge about vaccines. Therefore, this project aims to design formal processes, policies, and nursing education that will help address these critical issues. While there are policies regarding COVID-19 and flu vaccine requirements for employees, the vaccine clinic does not have policies or procedures for ordering, handling, storing, and administering vaccines. In addition, no formal processes exist for annual competencies or standing orders for administering vaccines, along with a measure of outcomes and cost. Using the latest evidence-based practice will be essential in formulating this vaccine clinic's policies and procedures. Ways Project Contributes to Intended Recipients Constructing formalized policies and procedures on vaccines emphasizes the importance of education that will benefit both nurses and patients. Nurse knowledge and perception of vaccines influence the education they provide to patients. The nurses' ability to establish relationships and openly communicate with patients could increase patient safety and vaccine uptake (Loftus et al., 2021). Likewise, staff that follows policies and procedures can reduce patient harm and avoid malpractice claims (Patient Safety & Quality Healthcare, [PSQH], 2017). Rationale for Importance of Project Policies and procedures promote a standard of care, reduce practice variation within an organization, adhere to accreditation standards, and serve as a vital resource that employees can 6 refer to as needed (PSQH, 2017). In a quantitative study, nurses participated in immunization training. Before the training, a pretest showed nurses' lack of basic vaccine knowledge. The postimmunization training tests showed increased knowledge, indicating the importance of vaccine education for healthcare workers (Loftus et al., 2021). Nursing education is just as important as providing education to patients (Siddiqui et al., 2022). Providing patient education helps the patient understand medication management, such as signs and symptoms to watch for, the purpose, the mechanism of action, and the potential adverse events of the vaccine (AHRQ, 2021). Literature Review and Framework A literature review was conducted to identify ways to create and improve policies, procedures, and education to reduce adverse events and increase patient safety when administering flu and COVID-19 vaccines. An evidence-based practice (EBP) change framework was selected to guide the implementation of this change. Framework The Knowledge to Action (KTA) Framework is used to make a planned change within a practice. Through the KTA framework, knowledge is acquired and then tailored to what is most helpful in implementing change. These steps are a part of knowledge creation and consist of knowledge inquiry, synthesis, products, and tools (University of Maryland School of Nursing, 2020). One may revisit and address these seven steps anytime: 1. Identify the problem. 2. Adapt knowledge to the local context. 3. Assess barriers and facilitators to knowledge use. 4. Select, tailor, and implement interventions. 7 5. Monitor knowledge use. 6. Evaluate outcomes. 7. Sustain knowledge use (RNAO, 2022, Knowledge to action framework). The KTA applies to evidence-based changes implemented in the new vaccine clinic. As stated earlier, the vaccine clinic must have vaccine education, policies, and procedures. The patients are the most critical stakeholders identified within the adaptation phase (RNAO, 2022). Other stakeholders include clinic and corporate employees, community members, and upper management. The development of a plan will consist of outlying supplies needed, cost, measurable outcomes, inventory, documentation, standing orders, education development, policies, and procedures. Potential barriers could include resistance from the nursing staff if they do not want to complete the required education and abide by the policies and procedures. In addition, several places in the area already administer COVID-19 vaccines, which could decrease the flow of community members receiving vaccines at this clinic. Selection and implementation of interventions will collect the latest EBP from the CDC and the state of Utah to determine best practice requirements for education and develop appropriate policies and procedures (RNAO, 2022). Monitoring of knowledge consists of preeducation and post-education surveys and annual competencies. Lastly, continuing annual competencies and meeting the state's requirements will help nurses sustain learning. Strengths and Limitations The KTA framework is highly versatile and can fit all shapes and sizes of projects within healthcare. It offers flexibility on when and how to use the seven steps and can be used with other conceptual frameworks to strengthen the project's content (Field et al., 2014). The addition 8 of conceptual frameworks could become beneficial to address limitations like a barrier to knowledge. Additionally, this framework's flexibility allows for combining the monitoring and sustaining steps, which could address some confusion because of the similarity. One of the most significant limitations of the KTA framework is knowledge barriers that could be affected by a lack of time and resources. Using established taxonomies to evaluate potential obstacles is the most effective method to address limitations. It is essential to have outside consultations to identify any barriers (Field et al., 2014). Analysis of Literature The review of current literature helped to assist in the formation of a PICOT question: Does a formalized process for providing nursing education for flu and COVID-19 vaccines, compared to no education, decrease the incidence of medication errors in vaccine clinics? An extensive literature review identified how lack of nursing education is an issue for patient safety and how to address this issue—resulting in the identification of three themes for this literature review. Search Strategies The literature search used Google Scholar, Medline, and CINAHL databases, but Google Scholar yielded the most helpful literature. Keywords used in the literature search were vaccines, education, nurse, COVID-19, medication errors, five medication rights, and policies. Articles from 2018 and newer ensure the most up-to-date vaccine information for the literature review. Most reports were from 2020 to 2022 because of the global COVID-19 pandemic 2020. The literature review revealed three overarching themes about how vaccine education and safety could be a problem and solutions to improve patient safety. The themes were avoiding 9 medication errors, the nurse’s role in patient education and perceptions of vaccines, and following CDC recommendations. Avoiding Medication Errors A significant theme in the literature is that medication errors are a common concern when administering vaccines. This issue is problematic because medication errors can cause long-term harm to patients and be expensive. The National Coordinating Council for Medication Error and Prevention defined a medication error as: "any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer" (2019, What are Medication Errors). There are many reasons that medication errors occur when administering vaccinations. According to Kim et al. (2018), the most common occurrences of these errors are administering the wrong dose and giving the medication at the wrong time. This study recommended correcting these errors by providing frequent education to nurses, enforcing policies, and requiring facilities to evaluate and update policies and procedures often (Kim et al., 2018). However, research suggests there are other causes of medication errors. The CDC indicated that improper compliance with the five medication rights is a common cause of vaccine administration errors, resulting from distraction, poor training, lack of protocol, and changes in recommendations (2021). Several studies found a relationship between a nurse’s education and the incidence of medication errors. Five studies by (Asad, 2015; Chang & Mark, 2009; Di Muzio et al., 2017; Kendall-Gallagher & Blegen, 2009; Sheu et al., 2009) noted that higher levels of education resulted in fewer medication errors (Kerari & Innab, 2021). Another study found that nurses who attended regular medication administration training had fewer medication errors (Kerari & Innab, 10 2021). In contrast, the authors found that medication error frequency increased when nurses had no training (Kerari & Innab, 2021). In a related study, the authors found that nurses may lack sufficient knowledge about vaccinations (Abdulla et al., 2020). However, the authors concluded that vaccine education improved nursing knowledge about vaccines, safety, efficiency, and contradictions (Abdulla et al., 2020). It is essential to understand that medication errors are a concern for immunization clinics. Knowing what behaviors lead to a higher incidence of medication errors is also valuable. This way, the clinic can understand the importance of nurses' education levels and the value of providing regular training to decrease the possibility of medication errors. This knowledge can help the clinic to develop future policies, procedures, and educational plans to address these issues. The Nurse’s Role in Patient Education and Perceptions of Vaccines In addition to stressing the importance of nursing education on the incidence of medication errors, research also suggests that education is essential in other ways. For example, research indicates that nursing knowledge and perceptions can influence patients’ perceptions and vaccine compliance (Glenton et al., 2021). One study found that when nurses take the time to develop positive relationships with patients, patients are more likely to receive vaccinations (Loftus et al., 2021). A meta-analysis found some improvement in vaccine uptake when healthcare providers were sufficiently educated about vaccines (Siddiqui et al., 2022). This theme shows that nurses are critical in educating patients about vaccines. It is essential to help nurses understand that patients rely on them to be knowledgeable about the interventions they provide. Nurses must also know that when they take the time to educate patients, this builds trust, which can improve vaccine uptake among patients. 11 Following CDC Recommendations The CDC guidelines are considered best practices for healthcare institutions. The CDC collaborates with the Advisory Committee on Immunization Practice (ACIP), which the Secretary of the U.S. Department of Health and Human Services formed. Before recommendations are made public, the ACIP reviews all scientific evidence about vaccines; then, the vaccine is licensed and reviewed by the CDC (National Foundation for Infectious Diseases, 2022). The CDC and ACIP utilize an evidence-practice method; grading recommendations, assessments, development, and evaluations (GRADE). This method uses vital factors to build vaccine recommendations about risks over benefits, quality of evidence, values of patients, and health economics. The CDC utilizes the evidence in the decision-making framework to formulate vaccine recommendations transparently (Lee & Carr, 2018). Established CDC guidelines are considered the golden standard for vaccine recommendations, storage, handling, and administration and will be utilized in building policies, procedures, and education for the new clinic. The Vaccine Storage and Handling Toolkit (2022) outlines details on storage and handling vaccines. Following the cold chain ensures that vaccines stay at recommended temperatures from production to administration. Maintaining recommended temperatures ensures vaccine potency and reduces adverse events, high costs, and loss of confidence in HCPs. Additionally, the Vaccine Storage and Handling Toolkit (2022) provides education on how to store vaccines in a refrigerator or freezer and maintain temperatures. It emphasizes the importance of having a primary vaccine coordinator, vaccine inventory, and how to perform regular and emergency transport. 12 The CDC outlines clinical considerations for approved COVID-19 vaccines. The Summary Document for Interim Clinical Considerations provides resources for the clinic about patient education and history, as well as scheduling and medication dosing for each vaccine type, including Moderna and Janssen (2022c). Another valuable resource from the CDC is You Call the Shots, an education module that outlines vaccine education from The Toolkit. Nurses taking the You Call the Shots module can receive continuing education (CE) credits upon completion (2022d). Resources like the Vaccine Storage and Handling Toolkit (2022) and You Call the Shots (2022d) have vast information. Using this information from the CDC is the standard of care, and using EBP will assist in formulating the vaccine clinic's education, policies, and procedures. Summary of Literature Review Findings and Application to the Project The three themes found for this literature review support the need for education and the importance of creating policies and procedures to be formed for this new vaccine clinic. HCPs can reduce medication errors by receiving proper education and having annual competencies with pre-and post-surveys; thus, nurses will continue to increase their level of knowledge. This new vaccine clinic will follow CDC recommendations as the standard of care. With the formation of education, policies, and procedures, the vaccine clinic can focus on reducing adverse events and increasing patient safety. Project Methodology This section will describe how the clinic will implement the proposed changes. The changes will require carefully reviewing the clinic’s current policies and education. Once these items have been reviewed, the clinic will use the CDC recommendations to ensure the new documents are complete and accurate. This section will also include a description of the team 13 members who will help to implement the changes and how the effectiveness of the change will be evaluated. This section will also review the ethical considerations associated with this implementation. Description and Development of Project Deliverables A PowerPoint (Appendix A) was created to introduce nursing staff to the new vaccine clinic and the expected timeline. A pre-and post-survey was created for nursing staff to gauge the knowledge of vaccine administration, storage, handling, and education (Appendix B). Two forms were created for consent for the vaccine and documentation. Both documents will be added to the employee file, and for community members, the forms will be uploaded under their profile in AdvancedMD (Appendix C). Plan and Implementation Process The clinic will receive Fluxelvax vaccines to immunize staff. COVID-19 vaccines will also be available for staff and community members. In addition to ordering vaccines, the clinic must ensure there are appropriately sized needles for intramuscular (IM) injections, syringes, band aides, and alcohol wipes stocked. Vaccine appointments will be no longer than 30 minutes to accommodate patients scheduled for other procedures in the clinic. An educational outline about COVID-19 and Fluxelvax vaccines will be uploaded to the company's training center, Trainual, by September. The education will include a pre-and postsurvey to assess the nurse's knowledge about vaccines and vaccine safety. The education for the flu vaccines will come from the following CDC documents: You Call the Shots, both Vaccine and Storage and Handling (2022a), Vaccine Administration (2021a), and Influenza (2019a). The COVID-19 vaccine education will be based on information from Interim Clinical Considerations for Use of COVID-19 Vaccines (2022d), Moderna COVID-19 Vaccine: What Healthcare 14 Professionals Need to Know (2022e), and Janssen COVID-19 Vaccine: What Healthcare Professionals Need to Know (2022f) Once complete, staff will upload the continuing education (CE) certificate to Trainual as proof of completion by the end of September before they will be allowed to administer vaccines. The clinic will follow the company's established policies regarding IM injections, the infusion reaction protocol, and the medication fridge temperature protocol. Moreover, the clinic must assign a primary vaccine coordinator to ensure proper vaccines are ordered, handled, and stored. The primary vaccine coordinator will also gain access to Utah Statewide Immunization Information System (USIIS) to record COVID-19 vaccine administration; it is essential to note that this is not required in Utah for flu vaccines. Interdisciplinary Teamwork The collaboration of interdisciplinary teams will ensure that the CDC recommendations are followed and that education is complete. The evidence shows that patient safety will increase when nurses are up to date with assigned education and policies and procedures are created and followed. Management. The manager is an essential member of the team. Management is responsible for giving final approval of the project. Management will also decide what vaccines to order and make a budget for the changes. The manager also receives reports of adverse events and gauges the vaccine clinic's progress. Education Team. The education team ensures that the clinic staff members are current in their education. They also make sure that education is annually assessed and updated as needed. They guarantee that annual competencies are performed and passed off by staff members. The 15 education teams also create policies and procedures that encompass specifics about vaccines, safety for administration, and storage. Medication Safety Team. The medication safety team reviews all adverse events and determines ways to make processes more accessible and safer. Members of the medication safety team include nurses and certified nurse assistants. Infection Prevention Committee. This committee meets monthly to discuss the latest changes and updates from the CDC and determines how those changes pertain to the clinic. They also create policies and procedures that address the CDC recommendations for infection prevention and control and ensure that the clinic and staff abide by them. Registered Nurses. The nursing staff ensures they are up to date on vaccine education and reports any problems or concerns to the appropriate teams. Timeline The proposed project implementation timeline is located below Appendix C. All clinics will order flu and COVID-19 vaccines and supplies to be available in clinics by the end of August. The clinics will start vaccinating staff by the end of September. Before administering a vaccine, the team must complete all assigned education. The administration of vaccines will continue throughout the rest of the flu season. Any staff members that choose not to receive the flu vaccine must wear masks in the clinic by October. The goal is to have 100% of staff vaccinated by March if not sooner, excluding religious or medical exemptions. There is no recommended stop date for COVID-19 vaccines. Starting in April, data will be collected to assess adverse events. All policies, procedures, and education changes will be updated by July to ensure clinics can complete any needed modifications for the following year. Plan for Evaluation of Project 16 The medication safety team will gather data from AdvancedMD (the clinic's electronic medical record) and of reported adverse events to evaluate the rate of vaccinations to adverse events. It will be essential for nurses and the medication error team to note what caused the adverse event. Possible reasons include a lack of proper education for nursing or patients, general vaccine side effects, improper storage, and handling, or vaccine preparation errors. Trainual will be used to identify knowledge gaps and attitudes toward vaccines by analyzing the survey results. Any significant gaps will be addressed via email, nurse, or committee meetings. Ethical Considerations Nurses have an ethical code to provide patients with dignity and integrity. The patient's well-being is the highest priority. Nurses must be aware of the ethical dilemma surrounding vaccines when educating and administering medications to patients. Vaccines should benefit the individual receiving the vaccine and not cause harm. However, the public’s view of vaccines has significantly changed, and individuals can opt out of vaccinations due to personal beliefs. It is the responsibility of HCPs administering vaccines to ensure that they follow current vaccine recommendations and educate the patient about risks and benefits (Amin et al., 2012). Additionally, patients' personal information must be constantly protected. The clinic’s current Health Insurance Portability and Accountability Act (HIPPA) policies will help ensure that patient information remains private. The newly created policies also safeguard the integrity of the medications by following the rules on handling vaccines from when they are received at the clinic until they are administered to the patient. Discussion This section of this paper will discuss how this project will benefit the nursing profession through policies, procedures, and education essential to patient safety. This section will also 17 discuss how the project will be presented to the interdisciplinary team, along with the strengths and limitations and recommendations from peers. Evidence-based Solutions for Dissemination This Master of Science in Nursing (MSN) project will be presented in a poster format. A poster was selected to provide a quick view of the information in this paper. The poster will highlight the themes that have been identified to strengthen policies, procedures, and education in this vaccine clinic. The poster will also include the strengths and limitations, framework, and evaluation. Additionally, it will also highlight the deliverables and timeline for this project. The poster will be presented to Weber State University faculty, clinic stakeholders, and content experts of this project. Significance to Advance Nursing Practice Nurses commit to lifelong learning, as healthcare is ever-changing, and the evidencebased practices that drive it. Nurses shape policies, procedures, and education to stay on best practices in patient safety and quality of care. Nurses can influence policies and procedures at high levels in their organizations and private, state, and federal levels (University of North Carolina Wilmington Online, 2021). Therefore, the nurses within this clinic can help shape the new policies and procedures to ensure patient safety. An essential part of a nurse’s commitment to patient care is staying updated with CEs to maintain the upstanding nursing profession. Like nurses' perception of vaccines, their perception of CEs influences their motivation to continue working on them. Education ensures that nurses are prepared to follow policies and procedures, practice up to date, and provide safe patient care. Allowing nurses to be involved in this clinic's education process will help motivate them to stay updated with the latest information (Mlambo et al., 2021). Developing policies and procedures 18 ensures that clinical processes are prioritized for patient safety. Policies and procedures can be shared with the organization and updated to ensure best practices. Implications This project's primary focus is on patient safety. Strengths for this project include providing valuable knowledge about vaccine storage, handling, and administration to nursing staff. One of the biggest strengths of this change is that this project can benefit the community. Nurses can help shape the vaccine clinic to benefit patients by safely handling, storing, and administering vaccines by establishing safe policies and procedures. Possible limitations to this project could be staff resistance to providing vaccines and their other required tasks. It might also be challenging for the nurses to finish their education by the deadline. Another limitation is that it may be challenging to advertise the vaccination clinic to the general public. In addition, because there are already several established vaccine clinics in the community, this clinic may get few participants. One way to reduce these potential barriers is to make nursing education fun and simple. To help the nurses feel this is manageable, creating a process for nurses to handle vaccine appointments quickly and efficiently will be essential. Marketing within the company can help promote this vaccine clinic, especially for established patients. Recommendations While patient safety and nurse education have been the drivers of this project, focusing on marketing the vaccine clinic to the public after successful implementation is recommended to keep the project in the minds of staff and the public. Initially, nurses will be educated about this vaccine clinic with a presentation. Nurses will ensure that annual competencies are completed, and policies and procedures will be updated as needed. 19 Conclusions The literature review found that creating policies, procedures, and education for HCPs promotes patient safety regarding flu and COVID-19 vaccines in a local clinic. The identified themes, avoiding medication errors, the nurse’s role in patient education and perceptions of vaccines, and following CDC recommendations, ensure a decrease in adverse events within this vaccine clinic. From the evidence found in the literature review, this MSN paper highlights the importance of having updated policies and procedures and ensuring that nursing staff is up-todate on vaccine education. Doing so ensures that patient safety is most important by reducing adverse events in this vaccine clinic. 20 References Abdulla, E., Johnson, J., Munir, S., & O'Dwyer, R. (2020). 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Influenza. https://www2a.cdc.gov/nip/isd/ycts/mod1/courses/flu/index.html CDC. (2022d). Interim clinical considerations for use of covid-19 vaccines. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-usappendix.html#append CDC. (2022f). Janssen covid-19 vaccine: what healthcare professionals need to know. https://www2.cdc.gov/vaccines/ed/covid19/janssen/10000.asp CDC. (2022e). Moderna covid-19 vaccine: what healthcare professionals need to know. https://www2.cdc.gov/vaccines/ed/covid19/moderna/10000.asp 21 CDC. (2022c). Summary documents for interim clinical considerations. https://www.cdc.gov/vaccines/covid-19/downloads/summary-interim-clinicalconsiderations.pdf CDC. (2022b). Vaccine storage and handling. Retrieved from https://www2a.cdc.gov/nip/isd/ycts/mod1/courses/sh/index.html CDC. (2019a). Vaccines storage and handling toolkit. Retrieved from https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html CDC. (2021a). Vaccine administration: preventing vaccine administration errors. Retrieved from https://www.cdc.gov/vaccines/hcp/admin/downloads/vaccine-administrationpreventing-errors.pdf CDC. (2021b). Vaccine information statement: influenza vaccine. Retrieved from https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf CDC. (2022g). Who needs a flu vaccine. Retrieved from https://www.cdc.gov/flu/prevent/vaccinations.htm CDC. (2022d). You call the shots. Retrieved from https://www.cdc.gov/vaccines/ed/youcalltheshots.html Field, B., Booth, A., Ilott, I., et al. (2014). Using the Knowledge to Action Framework in practice: a citation analysis and systematic review. Implementation Sci 9, 172. https://doi.org/10.1186/s13012-014-0172-2 Lee, G., & Carr, W. (2018). Updated Framework for Development of Evidence-Based Recommendations by the Advisory Committee on Immunization Practices. MMWR. Morbidity and mortality weekly report, 67(45), 1271–1272. https://doi.org/10.15585/mmwr.mm6745a4 22 Loftus, R., Sahm, L. J., & Fleming, A. (2021). A qualitative study of the views of healthcare professionals on providing vaccines information to patients. International Journal of Clinical Pharmacy, 43(6), 1683–1692. https://doi.org/10.1007/s11096-021-01299-y Kim PC, Shen JJ, Angosta AD, Frakes K, Li C. (2018). Errors associated with the rights of medication administration at hospital settings. J Hosp Health Care Admin: JHHA-111. DOI: 10.29011/JHHA-111. 000011 Kerari A., & Innab A. (2021). The Influence of Nurses’ Characteristics on Medication Administration Errors: An Integrative Review. SAGE Open Nursing. 7. doi:10.1177/23779608211025802 Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses' continuing professional development, a metasynthesis of the literature - BMC nursing. SpringerLink. Retrieved from https://link.springer.com/article/10.1186/s12912-021-00579-2 National Foundation for Infectious Diseases. (2022). US vaccination recommendations. Retrieved from https://www.nfid.org/immunization/us-vaccination-recommendations/ Patient Safety & Quality Healthcare (PSQH). (2017). Policies and procedures for healthcare organizations: A risk management perspective. https://www.psqh.com/analysis/policiesand-procedures-for-healthcare-organizations-a-risk-management-perspective/ RNAO. (2022). Knowledge-to-action framework. https://rnao.ca/leading-changetoolkit/knowledge-to-action Siddiqui, F. A., Padhani, Z. A., Salam, R. A., Aliani, R., Lassi, Z. S., Das, J. K., & Bhutta, Z. A. (2022). Interventions to improve immunization coverage among children and adolescents: A meta-analysis. American Academy of Pediatrics. 149(Supplement 6). Article e2021053852D. https://doi.org/10.1542/peds.2021-053852D 23 University of Maryland School of Nursing. (2020). Evidence-based practice models and frameworks. https://cf.son.umaryland.edu/NDNP804/module8/subtopic4.htm University of North Carolina Wilmington Online. (2021). How nurses can shape health policy. Retrieved from https://onlinedegree.uncw.edu/articles/nursing/how-nurses-shape-healthpolicy.aspx 24 Appendix A Employee PowerPoint Flu and COVID-19 Vaccine Clinic This clinic will be providing seasonal flu vaccines to employees and COVID-19 vaccines to employees and community members. 25 August 2022 Moderna and Johnson and Johnson COVID-19 vaccines will arrive at the clinic. 25g IM needles Fluxelvax vaccines will arrive at the clinic. Alcohol wipes Supplies will arrive at the clinic. Syringes Band aides Flu and COVID-19 education will be uploaded to Trainual with a pre-and post-survey. September 2022 Additional education includes IM and sub-q injections, infusion reaction, and medication fridge policy. The Primary Vaccine Coordinated will need further education (see email). Vaccines can be administered after the clinics nurse has completed their education. 26 Appointments will be made between infusion appointments. October 2022 Patient charts will be created in AMD, and consent and administration documentation will be uploaded to patients’ charts (see email for forms). Staff unvaccinated with the flu vaccine will be required to wear a mask. The medication safety team will review AMD charts. Evaluation will include: April 2023- July 2023 Adverse events Education provided to patients Problems with storage and handling Vaccine side effects Nurse’s feedback on the vaccine policies, procedures, and education Changes to vaccine policies will be updated. 27 Questions? 28 Appendix B Nursing pre- and post-survey questions 1. Is giving the patient the Vaccine Information Statement (VIS) a federal law? 2. Who cannot receive the flu or COVID-19 vaccine? 3. What is the preferred method to administer vaccines in adults? 4. What should the fridge temperature be to store vaccines? 5. There is no Pure Healthcare policy to follow for anaphylaxis. 6. I can pre-prep my vaccines every day for administration; even if I do not use all my vaccines, I can use them the next day. 7. What is the benefit of the vaccine? 8. What are not steps to administer vaccines? 9. What is a contradiction to administering a vaccine? 10. I feel confident about storing, handling, administering, and patient education about vaccines. 29 Appendix C Vaccine Consent and Documentation X VACCINE CONSENT/DECLINATION FORM Personal Information (PLEASE PRINT) Name: ___________________________Birthdate:________________________ AGE:_______ Address: _______________________________________________________ Sex: M / F City: ______________________________ State:_____________________ Zip:_____________ ☐ I am choosing to receive the X Vaccine. I have been given the CDC X Vaccination information sheet and read or have had explained to me information about X and X vaccine. I have had a chance to ask questions that were answered to my satisfaction. I believe I understand the benefits and risks of receiving the X vaccine and ask that the vaccine be given to me or the person named above for whom I am authorized to make this request (parent, guarantor, or guardian). ☐ I am choosing to decline the offered X Vaccine for the following reason. Please check all that apply. o Medical Precaution o Religious Belief o Other Reason: ____________________________________________________ o Prefer not to answer Signature: _____________________________________________Date:_________________ 30 X ADMINISTRATION FORM Print Name: ____________________________________________ DOB:______________________ ☐ I Accept the offered X Vaccine: ___________________________ Date: ____________ Please circle your answer to the following questions: 1. 2. 3. 4. 5. Have you received a X vaccine before? NO YES Have you had any problems with previous X or other vaccines? NO YES Are you immunocompromised? NO YES Are you feeling sick today? NO YES Have you received hematopoietic cell transplant or CAR-T- cell therapy? NO YES 6. Do you have a heart hx, bleeding disorder, hx of MIS-C/MIS-A, Guillain-Barre Syndrome NO YES 7. Comments: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Signature: _________________________________ Date: __________________ Employer: __________________________________ Date: __________________ 31 Timeline August September October March April July Ordering of vaccines and supplies Education completed before administering vaccines Unvaccinated staff must wear masks Stop flu vaccine administration for season Evaluation All updates and changes made to policies, procedures, and education Education assigned to employees on Trainual Vaccines open to administer to staff and community members Goal of 100% vaccination rates with staff