Educational Webinar: Advancements in Vaccine Management & Safety

Hello and welcome. This is Mary Beth Din from mckesson Medical Surgical. Today's webinar advancements in vaccine management and safety is being recorded to submit questions for our speaker. Please locate the Q and A panel in the lower left corner of your console. We also invite you to take a moment to review our disclaimer and we are excited to welcome today's presenter, Annie Pisco. Annie is a seasoned health care professional with over a decade of experience in the medical technology space. Her expertise in health care technology has allowed her to make significant contributions to the industry particularly in the field of vaccine storage. Currently, Annie serves as a valuable member of the team at True Meed System. Annie, I'll turn it over to you. Great. Thanks Mary Beth. Thanks for having me today and welcome everyone. Thank you for joining this webinar. Um As Marybeth mentioned, I'm one of the directors with Tred and we'll be getting into the advancements in vaccine management and safety today. Ok. So as you all know, vaccine management is a key component to health care systems today. And um while there's been significant advances technologically in health care delivery in many areas. Um There is significant improvement needed in vaccine storage and handling. So there hasn't been many changes over the past 40 years. Um So modern technology provides us that opportunity to improve vaccine workflow while ensuring vaccine um potency and patient safety. So today's objective, we'll first get into understanding some of the main challenges associated with vaccine storage and handling and then we'll touch on how modern technology can help improve patient safety. So what we found that many organizations that vaccinate, uh There are four main buckets of challenges that are part of vaccine storage and management. The first big bucket is all the specialized equipment that goes into just the set up of vaccine storage. Second, there's extensive and time consuming activities that take you away from patient care. So this could be anything from counting vaccines, um submitting an order tracking if there's been an excursion, a lot of time that goes into um managing vaccines and then third costly vaccine loss event. This could be anything from a power outage that leads to an excursion to simply leaving the door open on in a fridge that leads to an excursion as well or just simply miss tracking vaccines that all leads to loss and waste there. And then lastly, a big one is reputational risk. So there's always um the potential of patient safety errors. So administering the wrong vaccine um giving duplicates things like that. So these are the main challenges we see across um many organizations that vaccinate. So we'll get into these uh each a little bit deeper. So the first one specialized equipment. So as you all may be aware, the CDC Toolkit has an extensive 70 page um listing of requirements just for the set up and monitoring of your vaccine fridge. So here you can see some of those requirements that you may all be familiar with. Ideally a pharmaceutical grade fridge that has a probe and your Miss certificate and all the water bottles that are required to maintain that temperature. And then you can see the bins in there separating your stock. If you carry multiple types of inventory such as private and BFC. So that could be very similar to your current set up. You may have a whole separate freezer configuration or separate VFP configuration as well if you carry lots of VFP vaccines. OK. And then we're gonna get into highlighting some of the costly vaccine loss. So I like to show this visual here um of how easy it is to have many excursions in a vaccine fridge and how hard it is to maintain the appropriate temperature. So this is actually a study. Um The CDC did they placed about 20 probes throughout a um vaccine bridge and monitored excursions um over a two hour window and found that just opening the door over those two hours, eight times, there were many excursions happening to some of those vaccines depending on where they were placed throughout the fridge. So they are acknowledging how difficult it is to maintain temperature so that your vaccines are at the right potency for your patients. Ok. And then I touched on power outages. So there's always the possibility of a power outage. Um Many places can experience at least one power outage a year that can last at least three hours. Um So worst case this happens, say over the weekend or over the night, you're not aware, you have no alert, set up or backup system in place and come in the next day and your vaccines are spoiled. Um So there's always a possibility that these power outages can lead to excursions and loss from that as well. Um Or even simple unplugging of the system of the fridge. Um you know, maintenance may be going in and unplugging by accident of a vaccine fridge. So these are all possibilities um that you have to think about um these power outages that can lead to excursions again, that affect the potency of your vaccines that you're administering to your patients. Ok? And then what to do when you have an excursion. So um when this does occur, there's a lot of time that goes into managing this as well as you may be aware. So checking the data loggers to see how long they were out of range for according to VFC, as well as every manufacturer to see if those vaccines are spoiled or compromised at all, documenting what vaccines are in the fridge that you're reporting to those manufacturers, including the law and expiration, any previous excursions that have occurred. Um And then you may have to reschedule patients um as well because of this. Um you're still finding out if your vaccines are viable. Uh And then long power outages, you may have to transfer stock to a different clinic where there is power or another backup emergency plan. So all of this is just a, a big headache, an added challenge while you're trying to see patients and keep up with your um normal operation. Ok. And then how can we prevent the vaccine errors? So this is another big challenge is um cutting down or essentially eliminating as much as possible those common vaccine errors. So here we have those listed out. Um and how, you know, human error is possible, especially when you're moving quickly, you can easily grab the wrong vaccine. There is a lot that look alike, they sound alike um wrong dose. You may be choosing adult versus pediatric um tracking expired, making sure you're not giving an expired uh vaccine or even a recalled vaccine. And then wrong age is another big bucket um making sure that it's appropriate for the patient's age. So a lot of vaccine errors are um listed here that are common um and can potentially occur. Ok. And it's been found that um up to 25% of health care workers don't always check the expiration or if an item has been recalled before administering to a patient. And 48% of health care workers uh attributed this to lack of time. So, moving quickly having a lot of patients to see um and not always checking that critical information. All right, I'd like to show this uh pop quiz here just to really emphasize how easy it is um to grab the wrong vaccine. Um So these are some very similar looking vaccines here. The first photo on the left, can you tell which one is Havrix? Um Those all very similar to me, uh especially if I'm moving quickly and then on the right, which one is VVA, so all look very similar too. So um again, just showing how easy it is to, to make an error and give the wrong vaccine. OK. So we'll take a look at advancements in vaccine storage and handling. Um some changes that we have made um at AVA to help with a lot of these challenges that I've discussed so far. So ACU box is our all in one system, a fully automated vaccine fridge and freezer that's going to address all of those challenges that I've mentioned. So it combines all of those requirements needed by the CDC. In that previous slide, I showed no water bottles are needed, no bin separating your VFC from private inventory. It's a fully integrated system with data loggers built in and as you can see, it looks very different from a regular fridge or freezer. It's a fully enclosed system. So you are going to be getting the best possible temperature for your vaccine. Um No excursions, no temperature and fluctuation. Um I'm sorry, no, no fluctuation in temperature because of this fully enclosed system. So all staff have to log in with their fingerprints and choose their patient and vaccine from the screen. So everything is tracked and documented. So you know where every vaccine is going, there's essentially no loss with this system. Um and then they all get loaded into that top tray there, which I'll show in the next slide. So again, it's our fully automated system that provides ideal temperature control. And also another key um feature is it um counts your vaccines for you as well. So it's going to free up um the workflow for staff, we have a lot of time so you can focus more on patients. So as you can see here comes with a barcode scanner. So you simply hold up the um barcode on the box or the file and that scans the vaccine name the lot, the expiration and you identify whether it's going into your VFC private or other inventory in the system. And then the system, you load them into the tray and the system counts how many vaccines you have for you. So just by that simple scan, it is counting your inventory, documenting it locally on the ACU box. And then also on our online portal uh where, which is essentially a website that you can run temperature reports on inventory reports. See what your inventory is at the click of a button. Ok. And then it's also going to record your temperatures for you. So twice a day, um you'll be prompted to document the temperature by the click of a button on the screen for both the fridge and the freezer. Those temperatures get documented automatically online on that portal. And um it is um part of the reporting that you can provide if you carry VFC vaccines. Ok? And as I mentioned, it guarantees your temperature so very different from a regular fridge. No door that's opening and closing. All vaccines go into this this tray section you see here. So your temperature is ideal for your vaccine. Hi and it's going to count your vaccines for you. So get real time inventory count by the click of a button. No need to count or see what's next to expire. The system will always dispense the next to expire vaccine and we never dispense an expired vaccine. So extra patient safety checks built in to make sure you're not giving an expired vaccine. And then since it counts your inventory, you'll get notified when you're running low or when something is about to expire. So that can be via email or text or you can simply just run inventory reports on the portal. And then because of that, we can help with um simplifying reordering. Um Additionally, we have automated reordering with mckesson. So when you run low, you, it can trigger an order to mckesson to be automatically sent there as well to help free up time with that ordering. Ok. And then as I mentioned, no need to have been separating VFC private. The system does that all for you as you scan box scene in you're documenting whether it's going into VFC or private or any other inventory that may be stored in the system. Hey, and again, the portal is really gonna add to freeing up um staff time as well. That's where you're going to run inventory reports and you can run temperature reports from there also. OK. So back to this slide, Akiva can um address many of these common vaccine errors up to 91%. So it'll help uh prevent from grabbing the wrong vaccine, wrong dose, wrong age, not dispensing and expired, for example, and we do have the ability to integrate with EMR systems as well. So that's how a lot of these uh errors are avoided. So the order for the vaccine got placed in the EMR get sent to the AVA. And the staff simply select the order from the screen, confirm the vaccine, those get dispensed and then documented back on the patient's chart that they were given. So freeing up time. But also cutting down on error and not choosing the wrong vaccine. For example, you know, not choosing tap when it should be dap for example, OK. Additionally, ox has uh patient safety checks built in as well. So as box teams are getting dispensed from the system, it's going to reference any patient safety warnings that may be triggered. So for example, this one here, there's a warning on the patients. So this would be a screen that would show on the ACU box saying that it is not the the patient does not meet the recommended minimum age for the vaccine. So the staff can either override that and enter in a reason why they're overriding it or you know, say they made a mistake and they can hit, do not dispense and go back and select the right vaccine. If they do override, the caution is all documented on that portal where admins can log in and see if someone is repeatedly ignoring these warnings and why they're bypassing them. And additional patient safety checks include these ones here. So not only uh does it check patient's age, it'll check if the vaccine is um too close to the last dose given in the series, if the user has selected duplicates for any reason, but if the patient has already received all doses in the series and then it also reference the immunization schedule. So on the portal, we have defaulted in the AC IP schedule that can be um customized as well. Um If there's a different schedule that you follow, you can update it there. But as you take vaccines out for a patient, it's going, the system will reference that schedule. So it'll make sure that that vaccine is appropriate for that patient's age, but it'll also suggest other vaccines uh appropriate for the patient's age as well. So if you know they're due for a series of vaccines, they'll make sure that the system will make sure you take all of those out even during flu season. Um it can suggest flu. So if you haven't selected flu for a patient, it can suggest you give flu as well. OK. And then wanting to touch on the temperature control with AVA. So here we have an actual image on the right of the temperature in an AVA bridge as well as the temperature in an acu freezer. So the blue section is where the temperature needs to be per requirement. And then the white lines, for example, the fridge line at the top is right in the middle, that's the ava temperature of the fridge and then the freezer that has a few um divit we call them up and down, we called the ava heartbeat. That is um just the auto defrost cycle that occurs in the freezer. OK. So these are visuals that show on the cuva screen and again can be recorded twice a day to automatically document that temperature. Um temperature log required for the FC. So it records the current temp the minimum, the maximum for the past um 24 hours. So you can look at it for the past seven days as well. So the way that it uh maintains this ideal temperature is with those data loggers. Um So if you recall the um previous slide on temperature, the CDC, um those probes were um buffered, these probes, I'm sorry, those probes are buffered. These probes are un buffered in our system. So accurately measuring the temperature throughout the acu back. So there are five dialogs built in the fridge and two built in the freezer. So the system comes with the calibration needed for that as well as um the calibration certificate needed remote monitoring. So our team monitors um the temperatures as well to consistently make sure that these temperatures are in range to avoid excursion. And it touched on the alerting a little bit. Additionally, alerting with this system comes with um power outage alerts and temperature alerts. So if you're in a region of the country that experiences a lot of power outages, you can get notified when goes out via email or text or when the p and also when the power comes back on. Um so that um we'll touch on the battery back up in the next slide, but um you'll get notified of those power outages and any temperature concerns with the system that our team can help you with as well. And then lastly vaccine insurance. So um this includes vaccine coverage and replacement if for whatever reason, any vaccines are spoiled, we guarantee against that. Ok? And our um Akiva also comes with a battery backup. So in the case that the power goes out again, you will get notified that the power has gone out and you have x amount of battery left. So we guarantee at least eight hours of backup battery, we can see it last up to 15 hours. So this is an example of what the screen would look like. Your a box screen here. Again, you see the temps for the fridge and the freezer right there. But, um, you could just see that the power has gone out and the battery has kicked on. So, um, what's great with the backup battery is that you can still use the system. If the power has gone out, temperature still remains as long as that backup battery is kicked on. So you can still see patients throughout the day, they'll get vaccines out of the system. No need to worry about keeping, you know, the door closed, the system maintains that temperature during that power outage. Ok. And again, you can get notified that that power goes out or, um, also when the power comes back on. So what's great is if the power goes out, you have that peace of mind, you have at least eight hours to plan, you don't need to rush in. Um So this is great overnight or over the weekend, you're not coming in, you know, Monday or the next morning and finding that you've had an excursion. Um, and that vaccines are spoiled. So you have that peace of mind with the backup battery and the alerting as well. Ok. So just to highlight the alerting system as well, that comes with the ACU box that we've touched on. So these alerts again are via email and text for power outages, temperature alert. Uh The backup battery gets kicked on and then expiring inventory and low inventory. These are all documented on the portal as well. So typically the admins, you know, the vaccine liens or nurse managers would have access to the online portal where they can track these alerts, check their low inventory, see what's about to expire um and make the necessary changes or orders um from there. Ok? And this is fully user specific. So whoever wants to get set up for these alerts can and you can just get set up for one or all of whichever ones you'd like. Ok. So in summary, the AVA again is our automated vaccine fridge and freezer that counts inventory for you and guarantees temperature control for the vaccine. So um again, it's going to help save staff time so you can focus more on your patients. It counts all your vaccines for you. So that um by the click of a button. You can see how many in VFC you have, how many in private you have, how much of each specific vaccine you have as well. That's all available on the screen here or on the ACU box portal. You can see what's running low, what's about to expire and anything that's been recalled as well. We also track that. So that's all because of the scanner on the left side of the screen here that picks up the, the vaccine name, the lot number, the expiration N DC and tracks that with that vaccine as it gets stored in the system. And then it's gonna enhance patient safety. So we touched on those patient safety checks, checking on if it's been expired or recalled if the vaccine is appropriate for the patient's age or if they've received all doses and then the the ability for the system to integrate with the EMR and then third, it's going to eliminate costly waste and loss loss. Uh So again, it's a fully enclosed system, no door that you're opening, closing all the vaccines go in and out of the top tray section. Um We do have an extra drawer space in the front that is uh refrigerated and can be used as overflow storage as well for vaccines maybe during flu season when you have a lot of inventory. Um you can also store cold storage medications in there as well. And lastly, you can store um drawn up syringes. So if a patient refuses a vaccine, you can put the drawn up syringe in that um drawer, the refrigerated drawer so that it's available for the next patient to come in that same day. Um So we track that if it um expires later that day, you won't be able to give it to a patient, but that also helps cut down on waste because if a patient refuses at the last minute, you can still save that vaccine for the ne next patient to come in and track that within the system. Um So it is fully enclosed and it has the backup battery in case of power outages. And then the data loggers that are built in, I'll track that temperature for you to maintain the best temperature possible for your vaccine. So they're at the best potency for your patients. And then lastly, um it's an automated and integrated inventory system. So again, it counts your inventory. We have the ability to um do automated reordering with mckesson to free up your time. And um it's just a streamlined way to automate your vaccine management and um storage uh practice. Um So really taking into account modern technology to address a lot of those main challenges that were pointed out at the beginning of this presentation. Great. And that is all I have for the day. Thank you so much, Annie as a reminder, you can submit your questions in the Q and A box um for Annie about this presentation. So we have a few that came in already. Um So the first question here is what happens to the expired vaccines who takes them out? Who restocks the machine? Yeah, that's a great question. So if a vaccine gets expired is expired, um it'll be quarantined within the system. So you'll see on the inventory button on the acu vax, it'll separate what's been expired. So you can click in there and see your expired vaccine. You can also see that on the portal or get notified via email or text when something has expired. And then it's usually those admin level users who have access to everything in the system. Those vaccine leads nurse managers who are really managing the inventory that will have access to the remove feature that allows staff to remove vaccines if they've been expired, to allow for additional space in the acu box for other vaccines. Great. Thank you. The next question is um is this system and the technology, is it only for vaccines? So it can be used for cold storage medications as well? Um So you can store some in the top tray section depending on the size. Um some insulins will fit. Um And then the front drawer space that I mentioned is kind of like a mini fridge. Um So you have additional space there to put boxes of cold storage meds such as B fill in. For example, I see that sometimes um but it, it's mostly vaccines, but there is the ability to store cold storage meds. If they are vials, you can put them in the tray section like the vaccine or if they're bigger boxes or syringes, um, those can't be stored in the drawer section. And then additionally, um, if you have, um, many medications that you want to track, um, that are not necessarily, um, refrigerated, maybe, you know, you have large medicine cabinets. Um, we do have our acu shelf as well, which is a similar, um, inventory tracking device. It's essentially a tablet that you can, um, put near your, uh, medication cabinet. It comes with a scanner that you can scan just like the Akiva, you can scan the bar code on the medications and, um, it'll track how much inventory you have. Not only can it track medications, it can track supplies samples, even vaccines if you have a small vaccine fridge where you didn't wanna get, uh, and Ava. So, um, yeah, we have a combination of solutions to help with total practice wide inventory management. If you carry a lot of medications, either whether that be cold storage meds or not, the acu shelf is a great, um, device as well. Great. What is the capacity of the system? Yeah. So the acu box again is a fridge and a freezer. So the fridge is able to store 599 vials that can be, or, or syringes that could be single dose or multi dose vaccines. And then the freezer is is 100 and 19 again, single dose or multi dose whatever you carry. Um And then that drawer space that I mentioned in the front is additional space for overflow boxes or cold storage meds really depends on the configuration and the size of the boxes that you're putting in. Um But that could be an additional 300 doses. Wow, thanks. Um I think you pretty much answered this. But just to confirm the next question is, can you store all types of vaccines including COVID vaccines? Yes. Yeah, you can store any vaccine in the ox. Um We are able to scan all COVID vaccines. What's great is that um it tracks the beyond you date with COVID as well. So um if you're loading COVID vaccines into the freezer and then you wanna move it to the fridge, it will change that beyond you date based on that move date and time and then additionally with COVID and any other um multi dose vaccine, the system tracks how many doses you have in each vial. So you don't need to draw on the vials. Sometimes I see, you know, little dashes tracking how many doses are left. Not only does the system track how many multi dose vials you have, but how many doses are in each multi dose vial? Um And then a similar question I get a lot is is there a limit on how many VFC or how many private or how many of each vaccine you can load in. So you can barely load in this. However, you like, you could load it in with all private flu or you could do one box of each vaccine. You really tell the system what you wanna load. You select whether you're loading it into private or VFC or any other um program that you carry that's fully customizable. So even if you have V FA vaccines, for example, we can add that in. Um So you really customize your system, whatever you carry, the system can scan it and track your inventory. Got it. So the next question is, how would you label the syringe if the patient refuses and you put it back in the drawer? Yeah. So um the system has a button called reload. So if the patient has refused and you've already drawn it up prepared it, you can select that reload button document on the screen that it has been drawn into a syringe and the system will automatically open the drawer in the front and in the drawer, there's uh four tray sections for you to put drawn up syringes. So, um how you label those syringes is however you label them now in your current fridge. Um I think what I hear is, you know, try to have a label with that syringe. You don't want a free flowing syringe in the drawer even though the system is tracking what is in there. Um You just wanna make sure it's, it's labeled, however you do it. Now you can label that syringe. Um But the system tracks it. So if a patient comes in, uh patient number two comes in that same day and needs that same vaccine for that same program, the system knows that that one is the next to expire. So as the user selects that vaccine instead of pulling it out of the top tray, it's gonna automatically open the drawer for the staff and tell them to take from slot number one in the tray. Um So I think that answers the question. Yeah, just whatever process you follow. Now follow now with labeling um drawn up searches, you can do the same with a box even though the system's gonna track it as well. But just as an extra precaution, I would recommend whatever you do. Now on top of that. All right, the next question I think relates to the to the previous question. Um which is how do you return the multi dose files back into the machine? Yeah. So as you dispensed um vaccines from the system, uh you, you would select, you know, you say polio whatever multi dose you're taking, there's nothing different in the process with taking out a multi dose file. The system will go and grab that multi dose file. If there's one that's already been opened, it will go and grab that one. So you don't have to worry about having multiple multi dose files open at one time. Um But once, once the system dispenses that multi does file for you, they'll be a timer on the screen that says I pull has been checked out to user Annie and it's going to spoil in X amount of time. It depends on the vaccine. Um And you know, all different, especially with COVID vaccines, we track that. So let's say I pull, I think it's 45 minutes that usually shows or 30. So you have that time to draw the dose from the file and then load the file back in. So that timer is gonna kick down um run out, you don't want it to run out so you can log back in using your fingerprint, select the reload button or simply select the alert on the screen. And it's gonna ask you to document how many doses you used. So it defaults to one dose, assuming that you had it out for one patient, you could always change that to zero if you actually didn't give the dose or you could change it to two if you had it out uh for multiple patients. Um And then depending on the amount you document, it's going to deplete that from the amount left in the file and then you simply just hit reload and you put it back in the tray and it documents how many doses are left based on how many you gave? Great. Thank you. Um I think this is our last question. Um But you can keep on submitting them if you're, if you're listening. Um But this question is what EMRS does Avax integrate with? Mhm Yeah. So as I mentioned, the EMR integration is, is key for um you know, patient safety and time. Uh So we are integrated with um nextgen epic athena E Clinical Work office, Practicum and me and we are currently working with many more. So if you are curious about your specific one, you can certainly reach out to us. Um We are able to integrate with really any EMR um and can set up that integration. Uh So again, the way that works is the order gets placed in the EMR, it will cross to the Akiva screen. So the staff would log on see on the screen. A list of active orders that have been placed for that day, find their patient, confirm the vaccines that were ordered hit dispensed and the system goes to grab the next to expire for e for any of those vaccines comes out of the tray, they'll scan it out and it'll document back on the patient's chart that it was given. Um Most of the integrations include documenting N DC lot number expiration back on the patient's chart. Usually, what I see is you still have to go in and document the route of administration. Um but that's usually it so really cut down on error, choosing the wrong vaccine um and saving a lot of time with um documenting as well. Thank you so much, Annie that does conclude our Q and A section here. Um So thank you again, Annie for your expertise. Um This webinar was great. It feels like we're living in the future. This technology is, is very cool to learn about. So, thank you for your expertise and thank you to the audience for attending today's webinar. I invite you to please review our disclaimers one more time. And then we also invite you to please your upcoming webinars by visiting our website M MS dot McKesson dot com slash educational dash webinars. And to see what webinars we have coming up, we have a great line up through the summer in closing. I'd once again like to thank Annie and Tred for sharing her expertise with us and all of you for attending. Have a great day.