COVID-19 Vaccination Partners

LTCF, ALF, SNF, CCRC & Pharmacy Partnership, March 2021

Purpose

• Distribution of COVID-19 Vaccine to Residential Care Facilitieso Long-term

o IntegratedoSustainableoLow/No waste

Vaccination Efforts

Federal Vaccination Effort(Federal Retail Pharmacy Program)

• Go-Live Date: 4-8 weeks

• Estimated Length of Program: Unknown

• Participating Pharmacies: TBD

State Vaccination Effort(COVID-19 Vaccination Partners)

• Go-Live Date: Now

• Estimated length of Program: Indefinite

• Participating Pharmacies: Next Slide

Vaccine DistributionPharmerica

Northeast Pharmacy

HealthDirect Pharmacy Services

Omnicare of NH / CVS (Agreement Pending)

Vaccine to Sites

Vaccine Distribution

Pharmacy orders

vaccine from NHIP via

NHIIS.

Pharmacy ships vaccine to

LTCF.

LTCF staff document

vaccine administration

in VAMS.

NHIP receives federally allocated vaccine every week. Allocations vary and may consist of Pfizer, Moderna, and/or Janssen vaccine.

NHIP ships vaccine to Pharmacy where it can be temporarily stored in deep freeze or typical freeze before shipping to LTCF.

LTCF administers vaccine to patients and staff on rotating basis (1-2 times weekly).

Vaccine Presentation

Vaccine Presentation

◦ Current state allocation

◦ Previous Vaccine

◦ Doses per Vial = 6

◦ New Storage & Handling Guidelines

Vaccine Presentation

◦ Current state allocation

◦ Previous Vaccine

◦ Doses per Vial = 6

◦ New Storage & Handling Guidelines

Dosing / Administration:◦ 2 dose vaccine separated by 21 days (up to 42

days)

Storage:◦ ULT (deep freeze): between -90°C to -60°C

◦ Undiluted, frozen vials can be transported AND stored at between -25℃ to –15℃ for up to two weeks in addition to the 5 days refrigerated.

Presentation of vaccine◦ Diluent, Vaccine, and Ancillary Kit

Vaccine & Ancillary Kits

Pfizero 1 vial = 6 doses

• Diluent: 1.8 mL of 0.9% Sodium Chloride Injection (NOT bacteriostatic saline)

• Each dose is 0.3 mL

o 6 syringes with needles• Usually a mixture of 3 low dead volume and 3 “regular”

o 1 mixing needle: 3 mL syringe and 1.5” needle

o Alcohol prep pads

o Vaccination cards

Responsibilities

• Complete COVID-19 Provider Agreement

• Order Vaccine through the NHIIS from the NHIP

• Distribute vaccine to the sites they serve

• Communicate with sites to determine schedule that works for each site

• Support sites to ensure maximum efficiency/minimum waste

• Complete COVID-19 Provider Agreement

• Communicate: Order vaccine/set up clinics through Pharmacy

• Establish Medical Direction (if applicable)• Standing orders• Adverse Event Protocol & Epi*

• Document vaccine administration via VAMS/VMS (if applicable)

Long-term Care FacilitiesPharmacy Partners

Responsibilities

NH Immunization Program & NH DPHS

• Process & approve COVID-19 Provider Agreements

• Ship Vaccine to Pharmacy Partners

• Provide NHIIS training to Pharmacy partners

• Provide VAMS/VMS training to LTCF partners

• Provide Storage & Handling Guidelines to all

• Provide vaccine administration guidance to LTCF staff

• Provide support and guidance to LTCFs in creation of their own Medical Direction:• Standing Orders

• Patients/Residents• Staff

• Adverse Vaccine Reaction Protocol

• Administration of epinephrine

Questions and Answers

• How do we get started?o Complete a COVID-19 Vaccine Provider Agreement for your facility

o If you have not already done so, you can review and complete the COVID-19 Vaccine Provider Agreement by downloading the PDF on our website at: https://www.nh.gov/covid19/resources-guidance/vaccination-planning.htm

o Email completed agreement to: C19Enrollment@dhhs.nh.gov

o Review EUA Provider Fact Sheets and Storage & Handling guidelines/requirements for Pfizer-BioNTech, Moderna and Janssen (J&J) COVID-19 vaccines.

o COVID-19 Vaccine Provider Toolkit

Questions and Answers

• Can we bill for this?o Administration ONLY

o Vaccination = Reimbursement for Service (not vaccine)

o https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

• What will we be charged?o Epinephrine & Diphenhydramine

Questions and Answers

• What if we have leftover vaccine doses? o PREVENTION! Create your schedule before you order.

o Look for patients who have upcoming vaccine “appointments” or that meet the medically vulnerable criteria in Phase 1b, give them a 1st or 2nd dose.

o Look for staff who need 1st or 2nd doses.

o Call the nearest State run fixed site to see if they can utilize leftover vaccine.

o Call NHIP for help!

Questions and Answers

• Who can vaccinate? o Nurses (LPN, RN, NP, APRN)

o Medical Assistants (CMA, RMA)

o MD, DO, PA, DMD, DDS,

o EMT – Paramedic + Advanced EMT

o Pharmacist with OPLC endorsement

o Follow your sites Medical Direction

Questions and Answers

• What if our site doesn’t have a Medical Director? o Pharmacy Provider

o Affiliate Hospital

o RPHN

o Reach out to NHIP

Questions and Answers

• How will we enter patient information on administered vaccine?

o Training through NHIP and the NHIIS/VAMS team

o Reach out to NHIP

Questions and Answers

• Will Pfizer arrive already diluted? o Once diluent is added and vaccine is mixed there is a

limited window to administer. Talk to your Pharmacy.

• Can a “non-pharmacist” dilute?o Yes

o Refer to previous list

Resources

• Pfizer EUA Provider Fact Sheet

• Pfizer Patient Fact Sheet

• Pfizer Handling & Administration Guide

• Pfizer Diluent Guide

• Pfizer Vaccine Preparation

• NH COVID-19 Vaccine Management

• CDC Vaccine Storage & Handling Toolkit

• LTCF COVID-19 Vaccine Toolkit

• Vaccine Administration & Needle Length

• COVID-19 Vaccine Provider Agreement

Pfizer-Specific InformationGeneral COVID-19 Vaccine Info

Summary

The philosophy behind this initiative to create is a long-term solution to integrate COVID-19 vaccination operations into existing

models of delivery to ensure that our C19 vaccination efforts are effective and sustainable.

We are committed to establishing a process that works for you, the pharmacies that serve you, and the state’s vaccine effort. We welcome your input!

THANK YOU!