Managing Vaccine Waste

Each year, vaccine storage and handling errors result in significant financial loss from wasted vaccines and the revaccination of patients. When patients need to be revaccinated, they can lose faith in vaccines and providers. Proper handling and storage of vaccines can help protect patients and prevent vaccine waste. The CDC provides many resources for managing vaccine waste from handbooks and presentations to webinars and on demand courses. Below is an overview of the resources available.

The CDC’s Storage and Handling Resources main page is the hub for all resources. There you can find the Vaccine Storage and Handling Toolkit, an extensive guide to vaccine management. The toolkit can be downloaded from the website, and contains sections on  vaccine cold chain, training staff, inventory management, temperature monitoring, and more.

The main page also contains temperature monitoring best practices fact sheets for both refrigerated and frozen vaccines and a guide for handling a temperature excursion

The CDC also offers a course recommended for all immunization providers. The course is a self-paced document that averages 3 hours to complete, and CME credit is available. The course provides clinicians and other health care providers with ACIP’s best practices guidance on immunization.

The interactive, web-based immunization training course You Call the Shots contains a module on Vaccine Storage and Handling. This course also offers CME credit.

The Immunization Action Coalition provides a collection of handouts and fact sheets. These include signs to post in your clinic reminding staff not to turn off or unplug storage equipment, temperature logs, and various checklists.

For more information, see our blog posts on Handling Vaccine Temperature Anomalies and Refrigerator Repairs and on our LogTag temperature monitoring equipment discount for members. And remember, if you need to upgrade your vaccine storage equipment, CPP offers a grant to offset the cost.

Updated Vaccine Information Statements

The CDC released interim versions of several Vaccine Information Statements (VISs) on April 1. The CDC recommends providers begin using the updated statements immediately.

Below is a list of the updated vaccines and links to their Immunization Action Coalition (IAC) web pages.

A complete list of VISs can be found on the CDC’s website and the IAC’s website.

More Resources: Maintaining Immunizations During COVID-19

Children’s Hospital of Philadelphia (CHOP) has published an excellent guide to maintaining childhood vaccinations during the Coronavirus Pandemic. The piece warns that current factors related to the pandemic are creating a situation in which many children may be missed routine vaccines. This could result in a large population of unimmunized or under-immunized children and an increase in outbreaks of vaccine-preventable diseases (VPD).

The article continues by reporting data from the CDC on the circulation of VPDs between January and March 2020. In addition, it lays out solutions to continuing well child visits and routine vaccines. It ends with resources, some of which we listed in last weeks blog post Immunization Guidelines During COVID-19.

Be sure to check out this timely resource to assist your practice in maintaining routine immunizations.  

National Infant Immunization Week

Today kicks off National Infant Immunization Week (NIIW), a yearly observance of the importance of vaccinating children two years and younger. NIIW runs April 25-May 2, 2020 as part of World Immunization Week, a World Health Organization Initiative. NIIW highlights major achievements in the control of vaccine-preventable diseases and brings attention to the challenges that remain. An overview of NIIW can be found here.

The CDC’s NIIW hub provides a wide variety of resources for healthcare professionals to use during this week. The Digital Media Toolkit has social media messages, content, and materials for your practice to share. These include graphics pre-sized for Facebook, Instagram, and Twitter. In addition, the Toolkit has flyers, posters, infographics, and videos.

If you’ve been waiting for the right time to focus on building a culture of immunization in your practice, NIIW might be it! The CDC has a wealth of resources to help including a presentation on 10 Ways to Create a Culture of Immunization Within Our Pediatric Practice. This slide deck can be customized for your practice, and it comes complete with notes and guidance.  

Sanofi Pasteur also has a helpful resources for creating a culture of immunization called Developing an Immunization Culture in Your Office. This handout breaks down broad ideas concerning immunization culture into succinct, actionable bullet points.

NIIW is also a good time to review educational resources on immunization. The CDC provides resources for healthcare providers and for parents. The resources for providers equip healthcare professionals with the answers to many vaccine-related questions from parents. These include webinars, articles, printable resources, and social media content. In addition, providers can use the hub Provider Resources for Vaccine Conversations with Parents. These materials were created by the CDC, AAP, and AAFP.

We hope that your practice will take some time this week to reflect on the importance of infant immunizations and the profound impact these vaccines have had in reducing vaccine preventable diseases. Happy National Infant Immunization Week!  

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, our vaccine vendor partners have made the following updates to their ordering and payment policies:

NEW: Sanofi Pasteur – Effective April 13, 2020 Sanofi Pasteur will:

  • Extend current payment terms for an additional 30 days on invoices due in April and May 2020
  • Extend the 2% prompt pay discount on invoices due in April and May
  • Extension is retroactive to April 1, meaning any invoice due in the month of April will receive the additional 30 days

The 30-day extension applies to all purchases through Sanofi Pasteur or VaxServe via your Sanofi Pasteur sales representative, VaccineShoppe.com , 1-800-VACCINE (1-800-822-2463) or VaxServe.com and/or 1-800-752-9338.

Please note that since Merck has also extended their payment terms and prompt pay discount by an additional 30 days, invoices for Merck vaccines purchased through VaccineShoppe or VaxServe will also carry these same terms.

Pfizer – Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

Merck – Effective April 6, 2020, all open invoices for Merck vaccines purchased by Physician Clinic and Physician Practice customers through MerckVaccines.com, MerckOrders.com, or Merck Vaccine Customer Center beginning January 7, 2020 through April 6, 2020 will have 30 days added to their existing payment terms. No action is required on your part. A new invoice will not be issued; therefore, we recommend you simply make note of the additional 30 days to pay on your current invoice.

Additionally, all NEW orders placed by Physician Clinic and Physician Practice customers on MerckVaccines.com, MerckOrders.com, or through Merck Vaccine Customer Center April 6, 2020 through May 6, 2020 will have an additional 30-day payment term extension, for a total of 120 days to pay.

Please note that these extended payment terms apply to Merck vaccines purchased directly from Merck. For Merck vaccines purchased through a Merck Prime Vendor Distributor, please check with your distributor for current payment terms.

Immunization Guidelines During COVID-19

The CDC has released updated guidelines for preventative health services for children and adults during the COVID-19 pandemic. These include guidance on providing immunizations to patients.

Children

The AAFP and AAP have joined the CDC in offering guidance on maintaining childhood immunizations in the current pandemic. In order to continue to immunize pediatric patients, practices should follow guidance from the AAP on modifying clinic schedules and physical space. Recommendations include:

  • Limit well visits to early morning and use the remainder of the day for sick visits
  • Dedicate specific rooms for sick visits and well visits. If a practice has multiple sites, use one location for well visits only.

If a practice is unable to provide wells child visits for all patients in their practice, priority should be given to newborn care and vaccination of infants and young children through 24 months of age.

Adults

The American College of Physicians released a statement on non-urgent in-person medical care on March 23. This statement recommends the cancellation of elective and non-urgent procedures, and for physicians to move patient care to telehealth services when possible. The CDC recommends that adult immunizations be postponed except in two scenarios:

  • An in-person visit must be scheduled for some other reason and delivering preventative services during that visit will not increase risk.
  • An individual patient and their clinician assess that the benefit of the vaccine outweighs the risk of exposure to COVID-19.

Additional Resources

CDC:

Administering vaccines when a child is sick

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

AAFP:

COVID-19: Guidance for Family Physicians on Preventive and Non-urgent Care

AAP:

Email address for member questions concerning COVID-19: COVID-19@aap.org

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, our vaccine vendor partners have made the following updates to their ordering and payment policies:

Pfizer

Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

Sanofi Pasteur

Many customers have credits accumulated on VaccineShoppe.com and can use these credits to pay current invoices. If a particular practice or group is in a huge bind and would like special consideration for paying invoices, they are invited to call customer service at 1-800-VACCINE.

Merck

Effective April 6, 2020, all open invoices for Merck vaccines purchased by Physician Clinic and Physician Practice customers through MerckVaccines.com, MerckOrders.com or Merck Vaccine Customer Center beginning January 7, 2020 through April 6, 2020 will have 30 days added to their existing payment terms. No action is required on your part. A new invoice will not be issued; therefore, we recommend you simply make note of the additional 30 days to pay on your current invoice.

Additionally, all NEW orders placed by Physician Clinic and Physician Practice customers on Merckvaccines.com, MerckOrders.com, or through Merck Vaccine Customer Center April 6, 2020 through May 6, 2020 will have an additional 30-day payment term extension, for a total of 120 days to pay.

Please note that these extended payment terms apply to Merck vaccines purchased directly from Merck. For Merck vaccines purchased through a Merck Prime Vendor Distributor, please check with your distributor for current payment terms.

2020-2021 Flu Vaccine Pre-Book Deadline Extensions

Sanofi Pasteur

The Flu vaccine pre-book deadline has been extended to April 30, 2020 for those who have not yet confirmed reservations for the 2020-2021 flu season.

AstraZeneca

The pre-book deadline to reserve FluMist doses for the 2020-2021 flu season has been extended to May 31, 2020.

If there are any changes or updates to this information, we will be communicating that accordingly.

Resources to Help Address COVID-19 Challenges

We have been pulling resources together from various experts to help you address challenges in the most financially impactful areas of running a practice. We hope these will be helpful in managing through this crisis:

  • Patient Care/Revenue
  • Staffing
  • Rent
  • Supplies/Vaccines

The resources have been posted to a newly added section of our website and will be adding and updating as more resources become available.

Emergency Preparedness: Packing Vaccines for Transport during Emergencies

In an emergency situation, you may need to transport vaccinations to a secondary location. The CDC has several guides to help plan for vaccine transport in a number of different scenarios.

Section Six (pages 22-24) of The Vaccine Storage and Handling Toolkit provides guidance for routine transportation, for example traveling to an off-site clinic. In these cases, the CDC recommends transporting with a portable vaccine refrigerator with a temperature monitoring device. However, in an emergency situation, that may not be available. In those cases, the CDC states you can use a conditioned water bottle transport system or, as a last resort, the manufacturer’s original shipping container. Never use a food or beverage cooler.

The CDC’s Guide for Transport during Emergencies contains instructions for using a conditioned water bottle transport system. This system uses frozen and then partially thawed water bottles to keep vaccines cool. Frozen gel packs or coolant packs are not safe to use as they may freeze vaccines. In addition to the water bottles, this transport method also requires insulating material such as bubble wrap or corrugated cardboard, hard-sided or Styrofoam containers, and a temperature monitoring device.

Access the CDC’s guide for detailed instructions on packing the vaccines in a conditioned water bottle transport system along with illustrations.

The AAP also has a guide for safely transporting vaccines in both emergency and non-emergency situations. The guide breaks down transport for frozen and refrigerated vaccines, and contains a list of resources for further information.

COVID-19 Resources and Updates from CPP

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, the influenza vaccine manufacturers have extended the pre-book deadlines for the 2020-2021 flu season:

  • Sanofi Pasteur – Deadline extended to April 30, 2020 for those who have not yet confirmed their reservations.
  • AstraZeneca – Deadline extended to May 31, 2020.

We are also working with our vaccine vendor partners to determine what can be done to ease the vaccine-related financial burdens facing practices at this time. Pfizer has provided the following update:

Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

We will communicate more as specific solutions are developed. Stay tuned!

Resources to Help Address COVID-19 Challenges

Below are some great resources we pulled together from various experts to help you address challenges in the most financially impactful areas of running a practice. We hope these will be helpful in managing through this crisis:

Patient Care/Revenue

Telephone Triage Protocols

Medicare Telemedicine

COVID-19 Coding

Staffing

Family First Coronavirus Response Act – National Compliance Update

Rent

Economic injury disaster loans (declared disaster area 1) for small businesses

Landlord negotiation – We are hearing that some landlords are open negotiating rent payment during this time. Clearly this will depend on existing contracts and relationships. Article from the National Law Review

Vaccines

Vaccine Storage Emergency Plan (CPP blog post)

CDC Maintaining Childhood Immunizations During COVID-19 Pandemic

We have posted these resources to a newly added section of our website and will be adding and updating as more resources become available.

Emergency Preparedness: Vaccine Storage and Handling

Emergencies can happen at any time. Whether it’s a severe weather condition, natural disaster, power outage, or unexpected closure due to a pandemic, the end result could compromise vaccine storage conditions. Practices should have standard operative procedures (SOPs) in place for such emergencies.

What if your office needed to close for an extended period of time? In that case, you may need a system for monitoring temperatures remotely. Consider purchasing a phone-enabled or internet-aware alarm to alert you of temperature excursions. Multiple staff members should be on the notification list to ensure appropriate action can be taken, if needed. In addition, your data logger should have enough memory to store at least one month of data, and the data recording should loop when memory is full. This FAQ document from the AAP contains detailed information on data loggers and vaccine monitoring.

Emergencies can happen anytime, including after hours. Work with your facility’s building manager to ensure emergency access. Your storage and handling SOPs should include instructions and a map/diagram for accessing vaccine storage units and the locations of flashlights, keys, circuit breakers, and other useful items.

In a situation where a storage unit is no longer functioning or during a power outage, vaccines may remain inside the unit as long as appropriate temperatures are maintained. It is important to not open the storage unit door unless power is restored or you need to pack the vaccines for transport. Monitor your digital data logger to determine when you need to take additional steps.

If you cannot monitor temperature inside the unit without opening the door, wait until power is restored to record the temperature. At that point, record the room temperature and the temperature inside the unit. Follow your procedure for a temperature excursion and be sure to mark effected vaccines “Do NOT Use” until a decision can be made about whether or not to use them.

If you have external temperature monitoring, record the room temperature and unit temperature as soon as the power goes out. Also record the minimum and maximum temperatures reached. If a temperature excursion should occur, follow your SOPs.

If you have a generator or backup battery power source, this can prevent the need to move vaccines to another location. Both generators and back up battery power sources must be tested quarterly and serviced annually. In addition, ensure you have enough fuel on hand to run your generator for 72 hours.

Even if your practice has a backup power source, you need to establish an alternative storage facility. Establish a working agreement with at least on alternative storage facility such as a hospital, long-term care facility, the Red Cross, or a commercial pharmacy. Ensure that you have 24-hour access to your alternative facility. You can also have a back up storage unit at your facility to use as an alternate.

The CDC’s Vaccine Storage and Handling Toolkit includes a section for establishing SOPs and emergency management. These can be found on pages 25-26 and 30-34.

The Immunization Action Coalition produced a useful Emergency Response Worksheet. It includes instructions, a table for recording vaccines, and helpful numbers. If your practice is in the state of Ohio, the Ohio AAP has a Vaccine Emergency Management Plan with Ohio specific information.

Coming next: what to do in a situation where your vaccines must be transported.