Immunizations

Additional Resources

Practice Standards For All Healthcare Professionals
In 2013, the National Vaccine Advisory Council (NVAC) revised and updated the standards for Adult Immunization Practice to provide best practice recommendations for engaging all healthcare providers in assessing and providing appropriate, recommended immunizations to adult patients. Unfortunately, adult immunization rates are extremely low, and many adults are not even aware that they need vaccinations. As adults age, lifestyle and disease changes make them potentially eligible for different vaccinations over time, so it is vital that all healthcare providers--pharmacists included--follow these standards regardless of whether they actually provide immunizations. The Centers for Disease Control and Prevention (CDC) has offered grants across the country to increase utilization of these standards. Michigan Department of Health and Human Services (MDHHS) was fortunate to receive one of these grants and is working diligently to educate providers about using the standards in practice. Michigan Pharmacists Association is working closely with MDHHS to provide pharmacists with information about the adults standards and the importance of incorporating them into pharmacy immunization practices.

• • Standard 1: Assess
  • Assess all adult patients at every encounter for immunization needs. Health changes across the lifespan and the development of new vaccines necessitate repeat assessments over time. Some adults under utilize healthcare resources and may only interact with select providers for limited time; therefore, all providers need to be engaged in patient assessment, regardless of whether they actually provide vaccines. Taking advantage of every patient encounter to assess patient needs and educate about the importance of immunizations is critical to increasing adult immunization rates and creating a healthier, protected population.
  • • • CDC's Assessment Fact Sheet

• • Standard 2: Recommend
  • Recommend appropriate vaccines to each patient based upon his or her individual needs. Pay particular attention to recommendations based on chronic diseases such as pneumococcal vaccine recommendations for patients with diabetes. Strong recommendations from healthcare providers significantly increases the likelihood of the patient receiving the vaccine.
    • • • CDC's Recommendation Fact Sheet

• • Standard 3: Administer or Refer
  • If possible, administer the recommended vaccine during the same encounter. If your location does not offer the specific vaccine recommended, refer the patient to another provider who does offer it. Referral is especially important in situations where third party payers will not cover the cost of the vaccine administered in the pharmacy. Developing a collaborative relationship with other providers in your area along with your local health department can help facilitate these referrals. Letting other providers know which vaccines are available in your pharmacy is also important because that can provide added convenience to patients.
    • • • CDC's Administration Fact Sheet
        • CDC's Referral Fact Sheet

• • Standard 4: Document
  • Michigan is fortunate to have the Michigan Care Improvement Registry (MCIR) for documenting vaccinations. While it is not legally mandated that providers enter doses administered to patients over 20 years of age, it is a best practice that benefits the patient and the entire healthcare team. Consistent utilization of MCIR for documentation facilitates better recommendations because providers can rely on the accuracy of documented doses, rather than relying on patient recall.
    • • • CDC's Documentation Fact Sheet

• Centers for Disease Control and Prevention (CDC) Immunization Schedules
  CDC recommended immunization schedules are available online for children, adolescents and adults. Click on the links below to access the most recent schedules online. CDC also has a smart phone app for up-to-date immunization schedules. Additionally, they have created a Parent's Guide to Childhood Immunizations that can be helpful when discussing vaccination schedules with parents.
  
  
  • Child, Adolescent and "Catch-up"
  • Adult Immunizations

The Michigan Department of Health and Human Services (MDHHS) updated their immunization education materials. Utilize these documents to provide guidance to parents and guardians, school staff and pharmacy technicians and interns about the vaccines that are required for school and child care entry, as well as the importance of following the recommended immunization schedule for children and adolescents.

Links to these handouts:

• For Parents - Vaccines required for Child Care and Preschool in Michigan
• For Parents - Vaccines Required for School Entry in Michigan
• For Child Cares and Preschools - Vaccines required for Child Care and Preschool in Michigan
• For Schools - Vaccines Required for School Entry in Michigan
• For Health Care Providers - Vaccines required for Child Care and Preschool in Michigan
• For Health Care Providers - Vaccines Required for School Entry in Michigan
• Updated Fact Sheets on CDC's Vaccine Conversations with Parents 

• Pharmacy-based Immunization Delivery Program
   
  • There are three components to the certificate training program:
    • 12 hour (1.2 CEU) self-study modules with case studies and assessment exam
    • 8.0 hour (0.80 CEU) live seminar with final exam
    • Hands-on assessment of intramuscular and subcutaneous injection technique
    • The goals of the certificate training program are to:
  • Provide comprehensive immunization education and training
    • Provide pharmacists with the knowledge, skills and resources necessary to establish and promote a successful immunization service
    • Teach pharmacists to identify at-risk patient populations needing immunizations
    • Teach pharmacists to administer immunizations in compliance with legal and regulatory standards
       
  • MPA hosts several Pharmacy-based Immunization Delivery Programs throughout the year at different locations throughout the state of Michigan, as well as at our headquarters in Lansing. Please visit our online calendar to view any upcoming events, or contact MPA at (517) 484-1466 for the most up-to-date information.
     
  • For additional information about this program, developed by the American Pharmacists Association (APhA), please visit the APhA website.
     
• MPA Partnership for Immunization Training
  Michigan Pharmacists Association (MPA) will extend per person discounted registration rates for companies, retail chains and/or health-systems interested in implementing pharmacist immunization training within their organization. By assuming specific responsibilities associated with implementation of an APhA Pharmacy-Based Immunization Delivery Program, and fulfilling minimum attendance requirements, discounted amounts may be applied to registration fees. Click here for additional information!

• Michigan Care Improvement Registry (MCIR)
  The MCIR was created in 1998 to collect reliable immunization information and make it accessible to certain people online. MCIR benefits health care organizations, schools, licensed childcare programs, and Michigan's citizens by consolidating immunization information from multiple providers. This reduces vaccine-preventable diseases, over-vaccination, and allows providers to see up-to-date patient immunization history. MCIR also has the ability to assist with pandemic flu preparedness and can track vaccines and medications during a public health emergency.
  
  Pharmacies are strongly encouraged to report vaccine administration information to MCIR. This information assists MCIR in collecting reliable immunization information and making it accessible to health care providers online. For information on how to register your pharmacy/site and administrator, visit the MCIR website.

• American Pharmacists Association (APhA) Preparing Vaccines for Administration
  APhA provides a chart listing commonly-administered vaccines and information regarding their preparation. The FDA-approved labeling for the vaccines can also be found online.
   
• CDC Vaccine Storage and Handling Toolkit
  This toolkit is a comprehensive resource for providers on vaccine storage and handling recommendations and best practice strategies. The Vaccine Storage and Handling Toolkit is based on recommendations of the Advisory Committee on Immunization Practices, the manufacturer’s product information and studies from the National Institute for Scientific Technology. The toolkit outlines best practice and recommendations regarding considerations for equipment that includes storage units and thermometers, strategies for maintaining the cold chain, routine storage and handling practices, inventory management and emergency procedures for protecting vaccine inventories.
  
  Proper vaccine storage and handling practices play a very important role in protecting individuals and communities from vaccine-preventable diseases.  Vaccine quality is the shared responsibility of everyone, from the time vaccine is manufactured until it is administered. Additional information on vaccine storage and handling may be found on the CDC website.

• Administration Rates and Coverage
  This page provides general facts about adult immunization and links to other resources. For updated administration rates and resources, visit the CMS website. Scroll down to the ‘Downloads’ section for current reimbursement rates, an immunizer’s guide, a flu poster and more.
   
• Blue Cross Blue Shield of Michigan's Commercial Prescription Drug Plan Vaccine Program
  As of October 1, 2016, BCBS of Michigan expanded access to immunizations to many patients through their commercial plans under prescription drug benefits. BCBS created this FAQ document to assist pharmacies with proper utilization and billing procedures.
   
• Mass Immunizers and Roster Billing Fact Sheet
  If you decide to become a mass immunizer, you may take advantage of roster billing, which is a streamlined process for submitting health care claims for a large group of beneficiaries for seasonal influenza and/or pneumococcal vaccinations. Visit the CMS website to access a fact sheet on this type of immunization billing.
   
• Medicare Mass Immunization Enrollment Form
  Visit the CMS website to access the Medicare Mass Immunization Enrollment form.
   
• Medicare Part B Drug Average Sales Price (ASP)
  For updated fees and codes, visit the CMS website. Find the link on the left for the current year of ASP drug pricing files, then scroll down to the ‘Downloads’ section.
   
• Physician Fee Schedule Search
  This Web site is designed to provide information on services covered by the Medicare Physician Fee Schedule. It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). Visit the CMS website for additional information.
   
• Question and Answer Guide to Medicare Part B, Medicaid and CHIP Coverage of Seasonal Influenza and Pneumococcal Vaccinations
  This document addresses immunizers’ commonly asked questions about the administration of influenza and pneumococcal vaccines to Medicare, Medicaid and CHIP patients. It also includes questions and answers that are particularly relevant to the influenza immunization season. Visit the CMS website to access the guide.
   
• Quick Reference Information: Medicare Immunization Billing
  For quick reference information on Medicare preventative services, including Medicare Part B Immunization Billing (Influenza, Pneumococcal and Hepatitis B), visit the CMS website.
   
• Seasonal Influenza Vaccines Pricing
  Payment allowances listed on the CMS website reflect the annually updated payment allowance for the listed CPT codes and Q-codes when the seasonal flu vaccines are furnished outside the hospital outpatient department.

• Immunization Action Coalition (IAC)
  The IAC releases several publications for health care professionals who administer vaccines. These publications are reviewed by experts at the CDC and include information important for patients and the community. These are excellent resources for staying up-to-date with current changes in immunization standards and get answers to real-world questions.
  • Publications
    • IAC Express
    • Needle Tips 
    • Vaccinate Adults
  • Other Resources
    • Record keeping Handouts for Health Care Providers
    • Ask the Experts: Documentation Frequently Asked Questions
    • Standing Orders for Vaccines
    • State Laws and Mandates
    • Vaccine Pocket Guides
    • Directory of Resources

• Michigan Department of Health and Human Services (MDHHS)
  Michigan immunization providers are required to use Michigan-specific Vaccine Information Statements (VIS) because they include information about the Michigan Care Improvement Registry (MCIR). MDHHS updates new VIS from the CDC with the Michigan-specific information. They also offer VIS statements in a variety of languages.
  • Michigan Vaccine Information Statements 

• Alliance for Immunization in Michigan (AIM)
  AIM is a collaboration of public and private sector organizations working together to address the variety of immunization issues in Michigan. The Alliance provides resources, education and training for healthcare professionals throughout the state as well as valuable materials for patients and their families regarding recommended vaccination schedules for every stage of life. View the AIM Tool Kit to access free materials to share with colleagues and patients and learn more about how you can become involved in AIM’s efforts. 

• Precision Vaccination Immunization Newsfeed
  Updated on a daily basis, this newsfeed provides trusted news sources that have been vetted for commercial bias, clinical relevance and "main stream" comprehension by doctors, nurses and pharmacists. Organized by disease state, find vaccination information regarding the flu, hepatitis, herpes, measles, Zika, travel related vaccinations and seniors all reviewed by medical professionals. Be sure to sign-up for the Immunization Newsletter and get these great updates delivered directly to your inbox! Find the newsfeed here. 

• iVaccinate
  The number of unvaccinated children in the United States is increasing as parents are refusing to vaccinate. The Michigan Department of Health and Human Services (MDHHS) and the Franny Strong Foundation provide information, tools and evidence-based data to aid Michigan parents in their decision to vaccinate. For concerned parents that would like to stay up-to-date with vaccines, recommend the iVaccinate website here. 
   
• Hepatitis A Outbreak Poster Materials
  • Hepatitis A Informational Flyer
  • Hepatitis A Risk Flyer
     The Michigan Department of Health and Human Services (MDHHS) Division of Immunization has developed pharmacy specific posters for your use to raise awareness about the hepatitis A outbreak in Michigan and identify high risk individuals for vaccination. Pharmacies are in a unique position to provide vaccines to patients who are at risk for hepatitis A. MDHHS is encouraging all pharmacies in the outbreak area to screen patients for hepatitis A factors and to strongly encourage at-risk individuals to receive the hepatitis A vaccine. Print and post/distribute the flyer to patients presenting themselves within the pharmacy.
     
• Advisory Committee for Immunization Practice (ACIP)
  The Advisory Committee for Immunization Practice (ACIP) provides a vaccine-specific recommendations and guidelines for vaccines currently on the market. It also addresses immunizations for healthcare personnel along with vaccine guidelines for emergency situations.
  • Recent Recommendations from ACIP:
    • Prevention of Hepatitis B Virus Infection in the United States
    • Immunization Practices for the Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak
       
• Food and Drug Administration (FDA) Complete List of Vaccines Licensed for Immunization and Distribution in the U.S.
  The FDA maintains a list of all vaccines licensed for immunization and distribution in the U.S., including flu vaccines. Immunization providers should check FDA-approved prescribing information for 2015-2016 influenza vaccines for the most complete and updated information, including (but not limited to) indications, contraindications, warnings and precautions. Click here to access the chart.
   
• Standing Order Protocols
  Standing orders authorize nurses and pharmacists to administer vaccinations according to an institution- or physician-approved protocol without a physician's exam. These programs have documented improved vaccination rates among adults. The Advisory Committee on Immunization Practices (ACIP) recommends standing orders for influenza and pneumococcal vaccinations. For more information, visit the CDC website.
  • Standing Orders for Administering Influenza Vaccines to Children and Adolescents 
  • Standing Orders for Administering Influenza Vaccine to Adults
     
• HealthMap Vaccine Finder
  The HealthMap Vaccine Finder promotes the availability of many forms and types of vaccines to the public.  It was designed to help individuals locate practices that administer a wide spectrum of adult vaccines. All providers have the opportunity to enter information on their vaccine services into the database. If you already have a Vaccine Finder account, now is the time to enter your data! If you’re not registered, visit the HealthMap website to sign up today. If you have any questions or need assistance, please contact Vaccine@HealthMap.org.