vaccine standing orders webinar...will answer questions at the end of the presentation. the slides...
TRANSCRIPT
December 12, 2019
VACCINE STANDING ORDERS WEBINAR
Housekeeping Items
During this webinar, everyone will be placed on mute.Please type in any questions in the question box. We
will answer questions at the end of the presentation.The slides can be downloaded by clicking on the
handouts in the GoToWebinar panel.The webinar will be recorded.The presentation, registration to access the recording,
evaluation, and CE information will be available after today’s webinar here: www.doh.wa.gov/YouandYourFamily/Immunization/ImmunizationNews/ImmunizationTraining/VaccineStandingOrdersWebinar
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Continuing Education Disclosure
The planners and speakers of this activity have no relevant financial relationships with any commercial interests pertaining to this activity.
Information about obtaining CEs will be available at the end of this webinar.
Trang Kuss, MN, MPH, RN Deborah Carlson, MSN, RN
Immunization Nurse Consultant Nursing Practice Director
Office of Immunization and Child Profile
Nursing Care Quality Assurance Commission
Tracie Drake
Program Manager
Health Systems Quality Assurance
Presenters
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Today’s Topics
Learn tips to successfully implement vaccine standing orders in your practice
Discuss the authority and role of nursing staff and medical assistants in vaccine standing orders
Learn about available vaccine standing order resources
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Vaccine Standing Order TemplatesImmunization Action Coalition
www.immunize.org/standing-orders/
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Authorize healthcare personnel to assess a patient’s immunization status and administer vaccinations according to an approved protocol
Streamline your practice workflow by eliminating the need to obtain a physician’s order each time to vaccinate each patient
Ensure patients are appropriately vaccinated
What is the purpose of vaccine standing orders?
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Strong evidence of effectiveness in improving vaccination rates
Recommended by the Advisory Committee on Immunization Practices and the Community Preventive Services Task Force
owww.thecommunityguide.org/findings/vaccination-programs-standing-orders
oUse of Standing Orders Programs to Increase Adult Vaccination Rates: www.cdc.gov/mmwr/preview/mmwrhtml/rr4901a2.htm
Why use standing orders?
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Who should receive vaccine
Are there any contraindications or precautions
Procedures for vaccine administration (e.g., vaccine name, schedule for vaccination, appropriate needle size, vaccine dosage, route of administration)
Required Vaccine Information Statement (VIS)
Management of possible medical emergency
How to report possible adverse events
What are the elements of a vaccine standing order?
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Implementation date and expiration date
Identify authorized provider who will approve standing orders
Specify who may carry out the standing order and in what circumstances, including supervision requirements
Staff training and ongoing competency assessment
Identify when communication with provider is required, inclusion and exclusion requirements
Specify documentation and authentication requirements
What are the elements of a vaccine standing order?
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Who is authorized to sign the standing orders?
o Standing orders are approved by a medical director in a healthcare setting, a physician, or other authorized practitioner
Who is authorized to administer vaccines using standing orders?
oDebbie and Tracie will discuss scope of practice for nurses and medical assistants
Who is authorized to sign standing orders and administer vaccines?
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Get Ready - Build leadership support
o Discuss benefits
o Identify lead person (an immunization champion)
o Agree which standing orders will be used
Get Set - Develop materials and strategies
o Create standing order protocols (remember available templates!)
o Explain standing orders program to staff
o Determine role of staff members (identify CHAMPIONS)
o Determine logistics and clinic flow
o Identify strategies for informing and identifying patients
Go! - Make it happen
o Implement
o Review progress
What are the steps to implementstanding orders?
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General Best Practice Guidelines for Immunization (contraindications and precautions)
CDC Immunization Schedules
Immunization Action Coalition
For clinical questions about the immunization schedule or vaccine recommendations, please send an email to: [email protected]
Resources
NURSING CARE QUALITY ASSURANCE
COMMISSION
DEBORAH CARLSON
Nursing Scope of Practice
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Practice of Medicine
o Any activity that involves puncturing of the skin
o Administration of any prescriptive drug
Registered Nurse (RN) and Licensed Practical Nurse (LPN) Scope of Practice
Advanced Registered Nurse Practitioner (ARNP) Scope of Practice
Comprehensive Assessment vs. Screening
Direction vs. Delegation
RN and LPN supervision Requirements
Registered Nurse and Licensed Practical Nurse Scope of Practice (PDF)
Nursing Scope of Practice Overview
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Nursing Scope of Practice
Defined Boundaries
• Federal Laws
• RCWs & WACs
• Interpretive Statements
Educational Qualifications
• Formal Nursing Training
• Knowledge
• Experience
• Training
• Competency
Standards of Practice
• Professional organizations
• Accrediting organizations
• Evidence-based nursing
Facility Boundaries
• Policies & Procedures
• Protocols
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Nursing Scope of Practice Decision Tree
If Yes to all questions, perform the activity
Is the act consistent with WA State Nurse Practice Act &
other regulations?
Is the act supported by
evidence –based research,
professional organizations or
interpretive statements?
Is the act supported by
facility policies & procedures?
Do you have the required knowledge,
skills & competency to perform this act
safely?
Would a reasonable & prudent nurse
perform this act in this setting?
Are you prepared to
assume accountability
for the provision for
safe care & the outcome of the
care given?
If No, at any point, STOP
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Care directives:
o Act as orders/direction
o Condition-specific/population specific
o Not prescribing – following directions/orders
Anaphylaxis and Epinephrine Law
Authorized provider
Standing Orders and Verbal Orders (PDF)
Nursing Scope of Practice Frequently Asked Questions
o Dispensing, Compounding, Legend Drugs, and Controlled Substances FAQs
What are Standing Orders?
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Standing Order Policy Example - Sumner Health Centre
New Mexico Department of Health: Immunization Protocol with Procedures and Standing Orders for Nurses Example
University of Texas Medical Branch Standing Order Policy Example
Standing Order Policy Examples
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Medical Record – Paper vs. Electronic Health Record (EHR)
o Consider whether the EHR can add standing order protocols and screening questionnaires within the system
o Consider processes to identify the nurse is following a standing order in the documentation system
o Consider authentication requirements and processes
Documentation
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HEALTH SERVICES QUALITY ASSURANCE
TRACIE DRAKE
Medical Assistants Scope of Practice
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RCW 18.360.010(3)
The following health care practitioners, acting within the scope of their licensure, may supervise and delegate to MAs:
Physicians or allopathic physician assistants;
Osteopathic physicians or osteopathic physician assistants;
Podiatric physician and surgeons;
Advanced registered nurse practitioners;
Registered nurses;
Naturopathic physicians; and
Optometrists.
Who Can Supervise and Delegate to a Medical Assistant?
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"Delegation" means direct authorization granted by a licensed health care practitioner to a medical assistant to perform the functions authorized in this chapter that fall within the scope of practice of the health care provider and the training and experience of the medical assistant.
Delegation
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"Supervision" means supervision of procedures permitted pursuant to this chapter by a health care practitioner who is physically present and is immediately available in the facility. The health care practitioner does not need to be present during procedures to withdraw blood, but must be immediately available.
Supervision
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RCW 18.360.060 states that an MA may be delegated a duty using protocols that does not involve clinical judgment or the administration of medication, other than vaccines.
The health care practitioner is responsible for determining whether a task meets delegation requirements to delegate using a protocol.
Delegation Using Protocols
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Is the MA competent to perform the task?
Does the task require the exercise of judgment based on clinical knowledge?
Does the task need complex observations or critical decisions?
Can the task be performed without repeated clinical assessments?
If the task is performed improperly, could it present life-threatening consequences or danger of immediate or serious harm
Delegation Requirements
@WADeptHealth
Program Manager
Medical Assistant Program
Tracie Drake
Medical Assistant Frequently Asked Questions
Want More Information?Contact:
360-236-4766
Scenario Examples
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Terminology
NCQAC's Nursing Practice Glossary of Termso Delegation: Transferring the performance of a nursing task
(that the person would not normally be allowed to do) to a competent individuals in selected situations following the delegation process.
o Direction: Instructions or orders to provide nursing services or carry out medical regimen under the direction of an authorized health care practitioner.
o Supervision: Providing guidance and evaluation for the accomplishment of a nursing task or activity with the initial direction of the task or activity; periodic inspection of the actual act of accomplishing the task or activity; and the authority to require corrective action.
o Authorized Health Care Practitioner: A licensed health care practitioner who provides general direction to the registered nurse or licensed practical nurse within the health care practitioner’s scope of practice: ARNP, MD, PA, DDS, DO, ND, DPM, OD, Midwife
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• Delegation principles and processes
• Individual nurse, patient, specific task - Not Transferable
• Delegating nurse is accountableDelegation
• Instructions or orders to carry out an activity
• Nurse is accountableDirection
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Scenario Example: Nurse-Run Immunization Clinic
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Scenario Example – Medical Assistant and RN Delegation
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At the Well Child Clinic, the clinical team includes 2 physicians, 1 ARNP, 1 medical assistant. The team is developing standing orders for all recommended childhood vaccines and has the following questions:
Who has authority to sign this standing order?
If a standing order is in place:
o Do the physicians and ARNP need to enter an order for vaccines for all patients if a standing order is in place?
o Can the physicians or ARNP give a verbal order for vaccinations?
o Can the MA carry out all the components of the standing order: determine which patients need to be vaccinated, screen for contraindications and precautions, and administer vaccine?
Scenario Example
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At the Healthy Family Clinic, the clinical team includes a medical director, 25 physicians, 10 ARNPs, 25 RNs and LPNs, and 10 medical assistants. The team has the following questions as they are setting up their standing orders:
Which non-physician care providers are delegated prescriptive authority to order vaccines?
Does a physician have to sign off on EACH vaccine order placed by a non-physician with prescriptive authority? Or is this covered by the standing order?
To whom does the medical director need to notify to implement a standing order policy? A lot of our clinics in this QI initiative are within health systems
Do you have advice on how we can implement delegating prescriptive authority to order vaccines to RNs?
Scenario Example
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Additional questions from the Healthy Family Clinic:
Can the RN screen the patient and the MA administer the vaccine?
Is it within the MA’s scope of practice to screen and administer the vaccine?
Are the RNs required to be physically present for an MA to follow a standing order?
If the clinic hosts an offsite clinic, can the MA screen and administer the vaccine without an RN physically present?
Scenario Example
Continuing Education
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Nursing Continuing Education
Upon successful completion of this activity, 1.0 contact hours will be
awarded. This continuing nursing education activity was approved by the
Montana Nurses Association, an accredited approver with distinction by the
American Nurses Credentialing Center’s Commission on Accreditation.
Successful completion of this continuing education activity includes the
following:
o Attending the entire CE activity or watching the webinar recording
o Completing the online evaluation: https://fortress.wa.gov/doh/opinio/s?s=VaxStandingOrders
Expiration date is 12/12/20
Send an email to [email protected] to request the certificate
If you have any questions about CEs, contact Trang Kuss at
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Continuing Education for Medical Assistants
This program has been granted prior approval by the American Association
of Medical Assistants (AAMA) for 1.0 administrative continuing education unit
Successful completion of this continuing education activity includes the
following:
o Attending the entire CE activity or watching the webinar recording
o Completing the online evaluation:
https://fortress.wa.gov/doh/opinio/s?s=VaxStandingOrders
Expiration date is 12/12/20
Send an email to [email protected] to request your Certificate of
Completion
To obtain continuing education units, Medical Assistants will need to email
the Certificate of Completion to: [email protected]
Questions?
Washington State Department of Health is committed to providing customers with formsand publications in appropriate alternate formats. Requests can be made by calling
800-525-0127 or by email at [email protected]. TTY users dial 711.
DOH 348-741 December 2019