Implementing a Pediatric Influenza Vaccination Clinic

Establish purpose and goal(s) of the clinic. Taking into consideration:

• Who is the intended population (only children, or families as well)?
• Will the influenza clinic be only for patients or open to other community members
• Are there any additional factors that need to be considered when vaccinating parents/non pediatric family members? Immunizing Parents and Other Close Family Contacts in the Pediatric Office Setting page provides more information.
• How many individuals are estimated to be vaccinated? Has enough vaccine been ordered to cover this number?
• What type of influenza clinic will this be? Drive through/curbside or in-office?
• Will the clinic have evening and weekend hours to accommodate working and in school families?
• How many individuals will be vaccinated through private insurance and how many through the Vaccines for Children (VFC) program? Ensure this is appropriately tracked and implemented.

Consider the following:
For an in-office clinic

• What areas can be designated for the clinic? Will these areas be used during non-clinic hours?
• Can proper physical distancing guidelines be followed indoors, according to current public health guidelines?
• Will the clinic disrupt the flow of regular clinic appointments? Or will the practice dedicate the entire space and time specifically for the clinic?

For a drive through/curbside clinic

• Is set up available for a drive through/curbside clinic? What supplies will be needed? Cones? Tables? Tent? If needed, allocate time for set up and break down.
• Plan for safety of patients and staff.
• Ensure flow of cars as to not block any roads.
• If a practice would like to do a drive through/curbside clinic and does not have the space, are there large open spaces nearby that can be utilized? Check to see what permission will need to be obtained, and if there are any potential liability implications on using external space.

Establish a contingency plan:

If weather or another deterrent arises, have a back-up plan in place.

When holding an influenza clinic, check your location’s liability policy. For drive through/curbside clinic, check with the landlord (if space is rented) and insurance on any issues.

Obtain Needed Materials and Supplies

• Ensure clinic has stock of needed materials and supplies.
• Reference CDC guidance for a list of supplies and other helpful information: Considerations for Planning Curbside/Drive-Through Vaccination Clinics and Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations.

Staffing
Develop a staffing plan and identify roles and responsibilities. Staffing plans should take into consideration the expected number of people who will be vaccinated.

Scheduling
When scheduling clinic hours and days:

• Identify a day and time in which adequate staffing is available. How often and frequently will the clinic be held (one time, weekly)?
• Set up times that are family friendly – outside of the work and school day, including evening and weekend times.
• Determine the number of patients you can reasonably vaccinate during clinic hours, considering the timing between patients.
• Identify a scheduling/registration process for patients and families (eg, online versus real time); consider using scheduling software.
• Determine when (eg, before or during) in relation to a patient’s clinic appointment your practice will distribute consent forms, conduct COVID-19 screening, provide Vaccine Information Sheets, verify insurance eligibility, and check for any contraindications.
• Anticipate plan for potential walk-ins.

Intake Process
When planning for a clinic, it is important to consider what your intake process will look like as it may look different for a drive through/curbside clinic or in-office clinic.

A possible intake process might look like the following:

• Check in patient and check for completeness of pre-visit information
• Perform a pre-visit COVID-19 questionnaire
• Advise patient to loosen or remove clothing if needed
• Collect any necessary forms for daycare and/or school that need completing
• Distribute the appropriate Vaccine Information Statement(s) (VIS) before each vaccine dose is given. It is the law. There are many acceptable ways to provide patients and parents with VIS. The ways to give a VIS are detailed on the CDC website.

Vaccine Administration and Documentation
Establish a workflow and assign staff to different tasks.

• Direct car to designated location and confirm the car is put in park (specifically for drive through clinic).
• Have appropriate signage displayed indicating the process for an in-office clinic.
• Ask for parent or caregiver assistance depending on the age of the patient.
• Confirm type of vaccine with the patient record and insurance; ensure the patient is receiving vaccine from the correct stock, either private purchase vaccine or from the Vaccines for Children (VFC) program.
• Administer vaccine.
• Document vaccine and other required and recommended information in medical record (if Wi-Fi available) or document on clipboard (eg, vaccine manufacturer, lot number, and date of administration; date VIS provided; site and route of administration)
• Vaccine Administration Protocols provide additional information.

• Consider the flow of patients and space to conduct intakes, acquire documentation (insurance, consent, other forms, etc), available exam room(s) to administer vaccine and handout VIS form, and post vaccination process (completing any necessary documents for the family).
• Have designated areas for patient check in/intake, vaccine preparation, vaccine administration, and post vaccine process. Have the clinic flow in one direction to avoid any congestion, with separate entrance and exit. Ensure physical distancing guidelines can be followed between and within each designated area.
• Designate an area for special-needs patients.
• Plan for vaccine storage (in office clinic vs drive through/curbside clinic)

Provide training at all staff levels, including front office staff, prior to the clinic. Training is critical and should be ensured that all staff are trained to answer common questions about the vaccine, as well as general questions relating to influenza and the clinic. If possible, cross train staff to provide flexibility during the clinic.

Provide staff training on:

• Talking to families about the importance of getting vaccinated and how to respond to frequently asked questions
• Cardiopulmonary Resuscitation (CPR) and basic life support (BLS)
• Infection control practices
• Documenting vaccines administered
• Vaccine storage and handling

Learn more on staff training here.

• Ensure equipment, supplies, medications, and a cell phone are available at all times, and that the practice’s emergency plan is up to date.
• Learn more on what equipment and supplies are needed here.

• Check to make sure vaccines ordered during pre-booking have been delivered. Vaccines come from different manufactures, and it is important to track and ensure each vaccine delivery.
• The Seasonal Influenza Vaccine Supply & Distribution page provides vaccine distribution information for the current season.
• If vaccines have been delayed, assess to see if the delay will affect scheduled flu clinic. Communicate any delays or postponement with patients.

Determine Strategy for Maintaining Cold Chain

• It is important to maintain recommended vaccine temperatures, even during vaccine clinics that may take place outside the office. It is important that influenza vaccine NOT be exposed to freezing temperatures, as this may render the vaccine ineffective.
• In general, total time using off-site vaccine storage should be limited to a maximum of 8 hours, although consideration should be given to transporting needed vaccines every 1-2 hours from your clinic refrigerator. The preferred option for vaccine storage is a portable vaccine refrigerator with a temperature monitoring device.

Additional information, including other options for off-site vaccine storage, can be found in the CDC Vaccine Storage and Handling Toolkit (see page 21).

Promote Your Influenza Clinic

• Promote your practice’s clinic online (eg, patient portal messaging and email, practice website, social media, blog) and/or through an on hold phone message, signage around the practice, and press release.
• Develop a promotion plan to address vaccine hesitancy, and awareness and education of the influenza vaccine.
• This Reminder/Recall page provides resources and tips to identify and notify parents of children who need to be vaccinated.

Think back to the goals and purpose of the clinic and be clear in the promotion of who the clinic is for.

• Only pediatric patients or family members as well?
• Appointment only or walk-ins are welcome?
• Can new patients attend the clinic or is it only for existing patients?

Other considerations:

• If pre-scheduling, provide instructions on setting up appointments.
• If needed, communicate other options if the clinic is unable to meet demands.

The Flu Campaign Toolkit provides resources to promote the influenza vaccine.

During the clinic, ensure physical distancing and enhanced infection control measures are in place and implemented.

• Disinfect and clean vaccination stations regularly during clinic timings, minimum every hour. Refer to the Guidance for Cleaning and Disinfecting for more information.
• Ensure all patients and accompanying members are wearing a well-fitting face mask that covers the nose and mouth. Face masks are not recommended for children under the age of 2.
• Ensure all staff are wearing appropriate PPE.
• Have items such as hand sanitizer, tissues, and wastebaskets easily accessible.
• Ensure staff is wearing identification cards or other identification (vests, shirts, etc.), as appropriate.
• Make sure physical distancing, mask guidelines, hand hygiene, and cough etiquette are followed by displaying signs as needed throughout either the in-office or drive through/curbside clinic.

During the vaccination process, ensure the following actions are occurring:

• Screen for eligibility if vaccination is limited to certain populations.
• Screen for contraindications and precautions.
• Distribute VIS(s) prior to vaccine administration.
• Vaccine is prepared in a designated area.
• Patient flow is being monitored to avoid drawing up unnecessary doses.
• Hand hygiene is being performed before vaccine preparation, between patients, and any time hands become soiled.
• Vaccinators are following manufacturer instructions and federal vaccine administration guidance related to dose, site, and route (see Epidemiology and Prevention of Vaccine-Preventable Diseases and CDC Vaccine Administration Resource Library).
• Each vaccination is being documented and patients are receiving documentation for their personal records. Including scheduling a second influenza dose, if required.

Refer to Vaccine Administration Protocols for more information.

• Monitor and document vaccine temperatures regularly throughout the day.
• Refer to the Vaccines Storage and Handling Toolkit for more information.

Ensure that:

• All remaining vaccine in syringes are discarded according to protocol.
• Any remaining viable vaccine is appropriately stored and handled to protect the cold chain.
  • Vaccine that has been drawn into syringes is recommended to be discarded at the end of the day, if unused.
  • Manufacturer-filled syringes that have not been activated (ie, have not had the needle guard removed or a needle attached) may be kept and used until expiration date.

• Update internal system with vaccines administered.
• Submit information on vaccines administered to the jurisdiction’s IIS.
• Report any suspected adverse events to VAERS.
• Evaluate clinic outcomes and lessons learned. If possible, send out a patient survey for feedback.