Vaccination Clinics

Particularly during the pandemic, physicians, other health care professionals, and practice employees should take every opportunity to reassure and educate patients and their parents about the safety and importance of timely vaccinations.¹ One way to facilitate routine vaccinations is a dedicated vaccination clinic that can be held in the office, under a canopy in the office parking lot, or set up as a curbside or drive
through service. If your practice is planning a vaccination clinic, MICA recommends the following considerations and guidelines.

Advance Planning

• • Publicize the vaccination clinic well in advance by e-mailing patients, sending letters to patients without e-mail addresses, posting notices on the website and in the office, and telling patients who call the practice.
    
    
  • Let patients and parents know what vaccines will be available: influenza, pneumococcal, meningococcal, varicella, tetanus, hepatitis, human papillomavirus, “routine” child and adolescent vaccines, and/or combination vaccines.
    
    
  • Specify if the vaccine clinic is limited to certain age groups, or, for example, if a pediatric practice will offer vaccines to adults.

• • Check the physicians’ or advanced practice professionals’ participating provider agreements with third party payors for service requirements or exclusions and coverage for services.
    
    
  • Whether the vaccine clinic is in the building or outside, develop procedures appropriate to the setting which address the following:
     
    • physical distancing;
      
      
    • enhanced infection control, including the use of gloves, hand sanitizers, and handwashing stations;
      
      
    • proper vaccine storage, handling, preparation, and administration;
      traffic flow and premises safety, especially if the clinic will be held in a parking lot;²
      
      
    • weather; and
      
      
    • observation of patients for at least 15 minutes after vaccination. At a drive-through clinic, this is particularly critical if the patient is also the driver. The CDC recommends that practices offer parking for drivers to wait the recommended 15 minutes. Where possible, the patient should remain in the vaccination area or in a staff-monitored parking area nearby. Depending on the number of patients in the recovery area at one time, designate one or more staff members to remain with these patients to visualize and monitor them for any issues.
      
      
  • Physicians and practices participating in the Arizona Vaccines for Children Program, through the Arizona Department of Health Services (“AZDHS”), should review the Program Operations Guide. AZDHS also issued “Considerations for Curbside or Drive-Thru Immunization Services for Children and Adults,” which states that these services should be provided by appointment only.³
    
    
  • If outside, ensure Internet availability, so that you can use tablets or other devices to access the electronic health record (“EHR”) and enter immunization information.
    
    
  • Create a checklist of supplies you may need immediately available at the vaccine clinic.⁴
    
    
  • Establish logistics and clinic flow and layout.⁵
     
    • Whether inside or outside, how will patients enter and exit?
      
      
    • If outside, what safety guidelines are needed? For example, passengers not being vaccinated should remain in vehicles, children should be supervised properly, and pets should remain at home.

• • Train staff to do the following:
     
    • Screen for contraindications and precautions by reviewing the patient’s vaccination history in the immunization information system (“IIS”), or electronic health or medical record (“EHR”).
      
      
    • Remind patients to bring their immunization record to the vaccine clinic.
      
      
    • Provide the patient or parent with after-care instructions.
      
      
    • Inform patients of any clinic requirements such as wearing masks, post-vaccination waiting periods, and clinic restrictions (patient age, vehicle type, number of patients per vehicle, etc.) Specify any requirements and restrictions in communications sent to patients or posted on the practice website.
      
      
  • Identify any additional staff training needs. Staff may need to practice:
     
    • proper storage and handling⁶,
      
      
    • accessing patients in a potentially limited space (including multiple patients in a vehicle, different vehicle heights), or
      
      
    • proper injection site identification and injection technique.
      
      
  • Plan for medical management of an adverse event, and make sure all staff understand their roles in implementing the plan.
    
    
  • Have a vaccine clinic dress rehearsal and evaluate the staff’s performance. A dress rehearsal may lead you to offer an appointment-only clinic.
    
    
  • With a recent amendment to the Declaration issued pursuant to the Public Readiness and Emergency Preparedness Act (“PREP Act”), the U.S. Department of Health and Human Services authorized state licensed pharmacists to order and administer vaccines to individuals ages 3 to 18, subject to several
    requirements. If your practice will use pharmacists to administer vaccinations to pediatric patients, review these requirements.
    
    

Clinic Day⁷

• • Staff must wear appropriate personal protective equipment, and patients and visitors must wear masks, unless the CDC has modified these recommendations by the time of the vaccine clinic.
    
    
  • Ensure appropriate physical distancing and enhanced infection control measures are implemented.
    
    
  • Provide the patient or parent with the appropriate vaccine information statements and a screening checklist for contraindications and precautions.
    
    
  • Review and assess the completed contraindications and precautions checklist, any pertinent information about the patient in the EHR and the IIS, and any additional vaccination records provided by the patient.
    
    
  • Obtain signed consent forms.
    
    
  • Instruct drivers to wait 15 minutes before leaving the clinic area.
    
    
  • The CDC recommends that each vaccinator draw up only one multidose vial at a time. This should be done in an area designated for vaccination preparation, not at individual vaccination stations. In addition, monitor patient flow to avoid drawing up unnecessary doses.
    
    
  • Ensure proper hand hygiene before vaccine preparation, between patients, and any time hands become soiled.
    
    
  • Employ appropriate vaccine administration practices, including:
    
    
    • aseptic practices for administration supplies (e.g., bandages, alcohol swabs, and syringes and needles);
      
      
    • proper patient positioning, such as patients being seated to prevent falls and opening vehicle doors to reach patients; and
      
      
    • identification of the recommended injection site.
      
      
  • Give patients a record of the vaccines administered.
    
    
  • Document all vaccinations in the IIS and EHR.

¹ For comprehensive information which can assist your practice in this effort, refer to The Centers for Disease Control (“CDC”) Interim Guidance for Immunizations Services During the COVID-19 Pandemic.

² The practice should review its general liability insurance policy to confirm coverage for accidents that could occur in parking lot settings, such as pedestrian-vehicle collisions, trip and falls, etc.

³ The CDC’s “Considerations for Planning Curbside/Drive-Through Clinics” states that practices should “[c]onsider offering clinic services by appointment only.” 

⁴ The CDC published a Supply Checklist. 

⁵ For layout and other pre-clinic planning considerations, the CDC offers helpful ideas.

⁶ The CDC offers guidance in the Vaccine Storage and Handling Toolkit. 

⁷ Refer to the CDC website for additional clinic day considerations and activities.

The content of this publication or presentation is intended for educational purposes only; is not an official position statement of Mutual Insurance Company of Arizona (MICA); and should not be considered or relied upon as professional, medical, or legal advice or as a substitute for your professional judgment. Consult your attorney about your individual situation and the applicable laws. The authors, presenters, and editors made a reasonable effort to ensure the accuracy of the information at the time of publication or presentation but do not warrant or guarantee accuracy, completeness, or currency of such information. As medical and legal information is constantly changing and evolving, check for updated information and consult your attorney before making decisions.