yukon immunization manual: section 11 - immunization · pdf file11.0 outbreak plan ......

Community Nursing

Yukon Immunization Program

Section 11 – Immunization Work Plans

2012 February

SECTION 11 – IMMUNIZATION WORK PLANS

Table of Contents

1.0 ALL NURSES WHO ARE AUTHORIZED TO PROVIDE IMMUNIZATION IN THE YUKON WILL MAINTAIN COMPETENCE IN IMMUNIZATION AND ADHERE, TO ALL COLDS CHAIN PROCEDURES ............................................................ 1

2.0 INFANTS AND YOUNG CHILDREN .................................................................... 2

3.0 CHILDREN AND ADOLESCENTS ...................................................................... 4

4.0 ADULTS ............................................................................................................... 6

5.0 TUBERCULOSIS ................................................................................................. 8

6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS ................... 9

7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS ................ 11

8.0 PERSONS AT RISK FOR RABIES .................................................................... 13

9.0 PERSONS PLANNING INTERNATIONAL TRAVEL ......................................... 15

10.0 ALL AGES / SEASONAL................................................................................... 16

11.0 OUTBREAK PLAN ............................................................................................ 18

Community Nursing



2012 February

Page 1

1.0 ALL NURSES WHO ARE AUTHORIZED TO PROVIDE IMMUNIZATION IN THE YUKON WILL MAINTAIN COMPETENCE IN IMMUNIZATION AND ADHERE, TO ALL COLDS CHAIN PROCEDURES

Standard Evaluation Strategies Status (Completed/

Pending/

Revised) Date

Nurses will:

1) a) successfully complete an immunization competence examination upon initial hire (within 6 weeks) and at the discretion of the Community Nursing Management

b) review Immunization Competencies For Health _Professionals

• verification of immunization competence is completed

• certificate of competence is issued

• personal learning needs identified

CNO will advise employee & PHCNIC/NIC when competence exam is complete and iPHIS account activated.

2) a)maintain immunization competence through completion of the immunization competence recertification examination every 2 years

b) review Immunization Competencies For Health Professionals

• recertification of immunization competence exam

• certification maintained up to date

• personal learning

needs identified

Eight weeks before recertification is required, exam will be sent to employee by CNO

3) review all communicable disease and immunization information distributed by Yukon Communicable Disease Control or Community Nursing Office.

• review of Community Health Nursing Program manuals is included in orientation of all new employees

Tracking system for verification of review of all communicable disease and immunization materials (i.e. nurse initials)

4) ensure proper storage and handling of all vaccines and related drugs

• cold chain standards maintained

Adhering to procedures as outlined in the Immunization Manual

Community Nursing



2012 February

Page 2

2.0 INFANTS AND YOUNG CHILDREN

By 6 years of age, 95% of children residing in the Yukon will be up to date in the primary immunization series, as per the current Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

1) complete a focused review of immunization rates for each vaccine for the following groups:

0 — 12 mths 12 — 36 mths 36 — 60 mths 60 — 72 mths

using iPHIS every 2 months

• eligible clients identified & notified

• review annual immunization rates (January) & discuss with Manager

• programming strategies reflect emphasis on improving immunization rates for each vaccine in each age category

• parents/guardian who refuse any or all vaccines for infant/child will have refusal documented in iPHIS

Audits through iPHIS run by nurse Facility specific and Yukon wide stats will be sent to each facility annually Use of "Exemption" in iPHIS.

2) incorporate immunizations into well child clinic visits

• documentation of primary immunization series at well child visits

3) implement a catch-up program for outstanding immunizations for children 3 years of age

• immunization status of 3 year olds indicates 95% are immunized to date (January)

Facility specific and Yukon wide stats will be sent to each facility annually

4) incorporate immunizations into the pre-kindergarten health assessment

• immunization status of 5 - 6 year olds indicates 95% are up to date (January)

• work plan reflects immunization in pre kindergarten health assessments

Facility specific and Yukon wide stats will be sent to each facility annually

Community Nursing



2012 February

Page 3

2.0 INFANTS AND YOUNG CHILDREN (CONTINUED)

By 6 years of age, 95% of children residing in the Yukon will be up to date in the primary immunization series, as per the current Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

5) complete accurate documentation of immunization and vaccine-related events on the approved immunization record (iPHIS)

• review of immunization deficiency reports as received from CNO & all corrective action taken

Immunization deficiency report sent from CNO

educate clients, parents, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program

• chart reviews; month-end reports reflect education strategies

Chart audits by PHCNIC/NIC

6) educate parents, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information

• chart reviews, month-end reports reflect education strategies

Provide education at each client contact

participate in national / territorial communicable disease prevention and immunization research and campaigns

• work plan reflects participation

Community Nursing



2012 February

Page 4

3.0 CHILDREN AND ADOLESCENTS

90% of children aged 7 to 18 years will be up to date with immunizations as per the Yukon Immunization Schedule except for MMR which is 95%


Pending/

Revised) Date

Nurses will:

1) complete a focused review of immunization status for all vaccines of all 7-18 year olds at least twice a year April & Sept) using iPHIS.

• eligible clients identified & notified and offered vaccines

• review immunization rates & those due for vaccines

• programming strategies reflect emphasis on improving immunization rates with appropriate vaccines for this age group

• parents/guardian who refuse any or all vaccines for infant/child will have refusal documented in iPHIS

Audits through iPHIS by nurse Use of "Exemption" in iPHIS

2) incorporate immunization into the school health program

• work plan reflects school immunization strategies

3) implement a catch-up program for outstanding immunizations at 15 years of age

• review of immunization status of 15 year olds indicates 75% are immunized to date _______ (enter mth)

• annual review of immunization rates for 16 year olds

Audits through iPHIS

4) complete accurate documentation of immunization and vaccine-related events on the approved immunization record (iPHIS)

• review of immunization deficiency reports as received from CNO and all corrective action taken

immunization deficiency report provided by CNO.

Community Nursing



2012 February

Page 5

3.0 CHILDREN AND ADOLESCENTS (CONTINUED)

90% of children aged 7 to 18 years will be up to date with immunizations as per the Yukon Immunization Schedule except for MMR which is 95%


Pending/

Revised) Date

Nurses will:

5) educate clients, parents, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program

• chart reviews; month-end report reflects education strategies which are documented on month end reports


6) educate parents, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information



7) participate in national / territorial communicable disease prevention and immunization research and campaigns


Community Nursing



2012 February

Page 6

4.0 ADULTS

75% of adults will be up to date with immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

1) Formally review immunization eligibility for Td/Tdap on all adults at least twice a year

• immunization rates reviewed

• programming strategies reflect emphasis on improving immunization rates for each vaccine

"Cognos" report sent to facilities by CNO upon request

2) incorporate immunization review with each client contact

• iPHIS review & client history inquiry reflects immunization status

Demographic update by facility clerk

Client(s) placed in wait queue

Immunization history reviewed by nurse during all client contacts

3) implement a catch-up program for outstanding immunizations

• programming reflects strategies to improve adult immunization rates

4) complete accurate documentation of vaccine-related events on the approved formats

• review of immunization deficiency reports received from CNO & all corrective action taken

immunization deficiency reports sent from CNO.

Community Nursing



2012 February

Page 7

4.0 ADULTS (CONTINUED)

75% of adults will be up to date with immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

5) educate clients, caregivers, general public, and other professionals on immunization and the Yukon Immunization Program



6) educate clients, caregivers, general public, and other professionals on credible electronic resources for communicable disease and immunization information



7) participate in national / territorial communicable disease prevention and immunization research and campaigns


Community Nursing



2012 February

Page 8

5.0 TUBERCULOSIS

100% of identified clients for TB screening will receive a tuberculin skin test in accordance with Yukon TB Standards


Pending/

Revised) Date

Nurses will:

1) perform tuberculin skin test screening on candidates based on Yukon-specific and Canadian guidelines

• chart reviews demonstrate tuberculin skin testing according to Yukon and Canadian guidelines


2) complete accurate documentation of tuberculin skin test screening as per Yukon guidelines

• Tuberculosis Screening HLTH 939 forms completed accurately & copy retained on client file

3) forward tuberculin skin test screening results to Yukon Communicable Disease Control as per Yukon guidelines

• chart reviews demonstrate that Tuberculosis Screening for HLTH 939 forms have been forwarded to YCDC —TB Control

4) educate clients, parents, caregivers, general public, and other professionals on tuberculosis and tuberculosis screening

• work plan reflects public education programming on tuberculosis and tuberculosis screening

• chart reviews demonstrate client education on tuberculosis and tuberculosis screening


5) participate in national / territorial tuberculosis surveillance, prevention, and screening campaigns and research


Community Nursing



2012 February

Page 9

6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS

95% of health care providers and emergency responders will be up to date with immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

1) offer EMS & health care personnel history inquiry reflects Immunizations and/or immunization status serology testing at every contact

• iPHIS review & client history inquiry reflects immunization status

Review history at first contact and/or during orientation.

2) maintain a list of Hepatitis B vaccines given to EMS personnel

• list of completed Hepatitis B vaccines for EMS personnel sent to Financial Admin clerk by March 31st of each year for billing purposes

list of Hepatitis B immunizations for EMS responders maintained

3) implement a catch-up program for outstanding reflect emphasis on immunizations

• programming strategies reflect emphasis on improving immunization rates for eligible recipients

Community Nursing



2012 February

Page 10

6.0 HEALTH CARE PROVIDERS AND EMERGENCY RESPONDERS (CONTINUED)

95% of health care providers and emergency responders will be up to date with immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:



Immunization deficiency reports sent from CNO

5) provide education to eligible vaccine recipients on relevant communicable diseases and immunization

• chart reviews demonstrate teaching regarding communicable disease and immunization

Targeted in service sessions


6) inform health care providers and emergency responders of credible electronic resources for relevant communicable disease and immunization information

• chart reviews demonstrate teaching regarding credible electronic resources for information on communicable diseases and immunization

Community Nursing



2012 February

Page 11

7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS

95% of individuals with specific chronic diseases (i.e. Hepatitis, HIV, asplenomegaly transplant) will be up to date with client specific immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:

1) complete a focused review of immunization history for persons known to have specific chronic diseases / conditions (through use of chronic disease list)

• at least once a year iPHIS immunization record reviewed

• programming strategies reflect emphasis on improving immunization rates for each vaccine

Review of iPHIS immunization summary


• patient history inquiry reflects inquiry as to immunization status

Demographic update by facility clerk

Client(s) placed in wait queue

Immunization history reviewed by nurse during all client contacts

3) implement a catch-up program for outstanding immunizations

• programming strategies reflect emphasis on improving immunization rates in individuals with chronic disease

Community Nursing



2012 February

Page 12

7.0 PERSONS WITH SPECIFIC CHRONIC DISEASES / CONDITIONS (CONTINUED)

95% of individuals with specific chronic diseases (i.e. Hepatitis, HIV, asplenomegaly transplant) will be up to date with client specific immunizations as per the Yukon Immunization Schedule


Pending/

Revised) Date

Nurses will:



Immunization deficiency reports sent from CNO.

5) educate individuals with chronic disease on recommended immunizations according to their specific need

• chart reviews demonstrate education on recommended immunizations specific to client need

Provide education at each client contact.

Document recommendations

6) educate individuals with chronic disease on credible electronic resources according to their specific need

• chart reviews demonstrate education on credible electronic resources on immunization specific to client need

Community Nursing



2012 February

Page 13

8.0 PERSONS AT RISK FOR RABIES

95% of individuals at occupational risk for rabies will be up to date with rabies immunization as per Yukon Immunization Guidelines


Pending/

Revised) Date

Nurses will:

1) perform rabies pre-exposure immunization as requested by members of the public with particular emphasis on high-risk persons including: • veterinarians • animal control workers • wildlife workers • hunters & trappers • spelunkers • environmental health

workers handling specimens

• with each at risk client who presents, discuss the risks, benefits and side effects of the vaccine and risk of disease

2) educate high-risk persons and members of the public on rabies epidemiology, pathophysiology, risk, and prevention, as well as post-exposure management

• programming strategies include rabies education initiatives when required

3) participate in rabies investigation for possible rabies exposures

• chart reviews demonstrate accurate completion of a Rabies Investigation Form

• YCDC/EHS are provided all required information.

Community Nursing



2012 February

Page 14

8.0 PERSONS AT RISK FOR RABIES (CONTINUED)

95% of individuals at occupational risk for rabies will be up to date with rabies immunization as per Yukon Immunization Guidelines


Pending/

Revised) Date

Nurses will:

4) administer post-exposure management in consultation with YCDC

• chart reviews demonstrate YCDC — nurse collaboration

5) complete accurate documentation of vaccine-related events on the approved format


Immunization deficiency reports sent from CNO.

6) participate in territorial surveillance campaigns

• work plan demonstrates participation.

Community Nursing



2012 February

Page 15

9.0 PERSONS PLANNING INTERNATIONAL TRAVEL

95% of individuals planning travel abroad will be immunized as per Yukon, Canadian, and International travel guidelines


Pending/

Revised) Date

Nurses will:

1) provide information on recommended immunizations specific to the client and travel itinerary

• Travel Planning form reflects information given to the client

2) consult with Whitehorse Health Centre as needed for information on recommended immunizations

• Travel Planning form reflects appropriate consultation

3) refer clients to Whitehorse Health Centre as required for specific immunizations (i.e. Yellow Fever)

• Travel Planning form reflects referral to Whitehorse Health Centre for specific immunizations.

4) provide recommended immunizations

• documentation of immunizations given accurately reflects recommended vaccines for specific travel.

5) complete accurate documentation of vaccine-related events on the approved format


6) educate the client, parent, caregivers on other infection-control practices (i.e. mosquito bite prevention, hand washing, safety of drinking water, etc.)

• chart reviews demonstrate education on infection-control practices related to international travel.

Community Nursing



2012 February

Page 16

10.0 ALL AGES / SEASONAL

Influenza and pneumococcal immunizations are up to date in 75% of eligible recipients ≥ 65 years according to Yukon Immunization Guidelines


Pending/

Revised) Date

Nurses will: 1) complete a focused review

of influenza rates at least • influenza review

completed by mid September & high risk clients identified.

Immunization Audit in iPHIS for pneumococcal coverage & eligibility (Clerk or Nurse) Review of "Cognos" reports provided by CNO weekly during flu campaign

2) complete a focused review of adult (>65 yrs) pneumococcal rates at least three times a year to determine eligibility

• pneumococcal eligibility completed in August, February and May

• clients who refuse pneumococcal vaccine will have refusal documented in iPHIS

Use of "Exemption" in iPHIS

3) implement a campaign annually to immunize eligible clients

• programming strategies reflect emphasis on improving immunization rates for influenza and adult pneumococcal rates in eligible populations

• Immunization rates post-campaigns reflect improved immunization rates.


• chart reviews reflect inquiry into immunization history.

Review of iPHIS record at every client visit

5) educate clients, parents, caregivers, general public, and other professionals on influenza and pneumococcal-related illness and immunization

• chart reviews and month-end reports demonstrate education initiatives.

Community Nursing



2012 February

Page 17

10.0 ALL AGES / SEASONAL (CONTINUED)

Influenza and pneumococcal immunizations are up to date in 75% of eligible recipients ≥ 65 years according to Yukon Immunization Guidelines


Pending/

Revised) Date

Nurses will: 6) educate clients, parents,

caregivers, general public, and other professionals on prevention of communicable disease (i.e. hand washing)

• chart reviews and month-end reports demonstrate education initiatives.

7) educate clients, parents, caregivers, general public, and other professionals on credible electronic resources for information on influenza and pneumococcal-related illness and immunization

• chart reviews and month-end reports demonstrate education initiatives

8) Participate in national / territorial influenza and pneumococcal illness prevention and immunization research and campaigns

• work plan reflects participation.

Community Nursing



2012 February

Page 18

11.0 OUTBREAK PLAN

Goal: Prevention of a vaccine-preventable disease in the midst of an outbreak of the disease, by providing access to and provision of immunization


Pending/

Revised) Date

Nurses will:

1) assess the scope of the outbreak by: • reviewing daily client

logs for patterns • maintaining a list

through a log or database of clinical and/or lab-confirmed cases from time zero to the end of the outbreak

• copy of log/ database submitted to Community Nursing Office as directed (weekly, monthly)

• log/database is comprehensive and complete

2) complete a focused review of immunization status for community members, health care providers or other specific target population (upon direction from YCDC / Community Nursing Management)

• work plan (see #4) demonstrates immunization status, risk status of community members

3) ensure an adequate stock of vaccine and related supplies are available in the health facility

• adequate supplies are in place in a timely manner.

Community Nursing



2012 February

Page 19

11.0 OUTBREAK PLAN (CONTINUED)



Pending/

Revised) Date

Nurses will:

4) complete a work plan for targeted mass immunization including: • mass public clinics

home visits (as required)

• evaluation of immunization status

• work plan reflects various strategies to quickly boost appropriate immunization rates

• work plan submitted to Community Nursing Office as directed (weekly, monthly)

5) enlist adequate resource supports (clerical, community) to

• adequate clerical and other supports are in place to enable nurses to focus on

6) implement a mass community awareness campaign (or complement an existing territorial campaign) on the applicable communicable disease and immunization

• community awareness strategies implemented.

Community Nursing



2012 February

Page 20

11.0 OUTBREAK PLAN (CONTINUED)



Pending/

Revised) Date

Nurses will:

7) implement a mass immunization campaign

• target timeframes for campaign established & maintained

8) evaluate mass immunization campaign effectiveness by collecting data including: • total number of clinical

cases • total number of lab

confirmed cases • total number of

vaccines / doses given • mortality numbers • morbidity numbers

• database (see #1) is utilized to generate a final report incorporating key data as outlined in #8

• database is forwarded to Community Nursing Office

9) complete accurate documentation of immunization and vaccine-related events on the approved immunization record


• post-outbreak iPHIS review of immunization records including adverse events, contraindications, recommendations).

• Immunization deficiency reports sent from CNO.

• Summary report will be generated by CNO

10)collaborate in a timely manner with appropriate stakeholders (YCDC, Community Nursing Management, other agencies, general (public)

• facility staff, nursing managers, and appropriate stakeholders indicate satisfaction at level of communication.

yukon immunization manual: section 11 - immunization · pdf file11.0 outbreak plan ......

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