NYC VFC Provider Requirements: Vaccine Management
Vaccine Personnel
All provider sites must designate a physician-in- charge, a primary vaccine coordinator and at least one back-up vaccine coordinator who is able to perform the same responsibilities as the primary vaccine coordinator in the event that the primary person is unavailable. These positions will be responsible for all vaccine management within the office. (See the Vaccine Management Job Aid (PDF))
The designated vaccine coordinator and backup will be responsible for the following vaccine management activities:
- Adjusting the temperature of a vaccine storage unit, and -
- Documenting the temperature on the temperature logs for each storage unit.
- Reviewing temperature logs weekly if daily monitoring is being conducted by the backup person monitors temperatures daily, the primary vaccine coordinator should review weekly. If the vaccine coordinator monitors temperatures daily, the backup person should review logs weekly.
- Training other staff who are responsible for administering vaccines or who may be required to transport vaccine in an emergency situation. A simple log sheet with the staff member's name and date of training should be kept as documentation.
- Unless otherwise noted, the vaccine coordinator and/or backup should be the VFC contacts for the office.
Vaccine Management Plan
The NYC VFC Program requires that all VFC providers have a Vaccine Management Plan and review it with their staff at least once a year. Providers may develop their own management plan or use the Vaccine Management Plan (PDF) template. The Vaccine Management Plan should be simple, and the processes outlined within it should be presented in a clear and concise manner. Both routine and emergency vaccine management components should be included in the plan. The emergency component should contain guidance on what to do in the event of refrigerator or freezer malfunctions, power failures, natural disasters, or other emergencies that might compromise appropriate vaccine storage conditions. Providers are required to develop policy, complete with protocols and procedures, for maintaining the vaccine cold chain during transport to off-site emergency storage locations.
- The routine vaccine management component should include guidance on the following:
- Ordering vaccines
- Controlling inventory
- Storing vaccines and monitoring storage conditions
- Minimizing vaccine wastage
- Vaccine shipping, including receiving, packing and transporting
- The emergency vaccine management component should include guidance on the following:
- Person(s) responsible for preparing and transporting vaccine, including contact information
- How this person will be notified that vaccine needs to be moved
- Location that will receive vaccine
- How receiving location will be notified of transport
- How to pack vaccine for transport
- Worksheet to document vaccine involved in power or equipment failure
For further guidance on what to include in your plan providers should look at the CDC’s Checklist for Safe Vaccine Handling and Storage (PDF).
Vaccine Inventory
Proper vaccine inventory management is essential for all VFC-enrolled providers. Providers should refer to How to Do a Physical Inventory Job Aid (PDF), when conducting vaccine inventory. Because providers are also required to submit current inventory of their publicly-funded vaccines every time they place a vaccine order, it is important that providers develop and maintain complete, accurate and separate stock records for both public and private vaccines. The requirement to keep separate records does not necessitate having separate storage units for public and private vaccines. Providers must be able to distinguish between their public and private vaccine stock. Proper documentation of all administered VFC vaccine doses will help to ensure this. (See Reporting Administered Vaccine Doses below)
For more guidance on best practices on vaccine inventory management, please refer to the CDC Storage and Handling Toolkit (PDF), pages 33-35.
Vaccine Borrowing
Vaccine borrowing should only occur in rare occasions when there is lack of appropriate stock vaccine due to unexpected circumstances such as the vaccine is about to expire or shipment delays due to vaccine unavailability or vaccine shortages. Providers are required to document all instances using the VFC Vaccine Borrowing Report and have documentation available to VFC Program staff during site visits.
Vaccine borrowing should NOT be a routine practice. VFC-enrolled providers are expected to maintain an adequate inventory of vaccine for both their VFC and non-VFC-eligible patients at all times. Vaccine borrowing should NOT change this expectation.
VFC vaccine cannot be used as a replacement system for a provider’s privately purchased vaccine inventory unless the vaccine is about to expire and a provider wants to avoid vaccine wastage. The provider must assure that borrowing VFC vaccine will not prevent a VFC-eligible child from receiving a needed vaccination because VFC vaccine was administered to a non-VFC eligible child.
Vaccine Transfers
VFC-enrolled providers needing to transfer vaccines must contact and receive approval from the program before attempting to transfer any VFC vaccines. Vaccine transfer requests are approved on a case by case basis and generally in the event of an emergency.
- Such emergencies consist of:
- refrigerator/freezer malfunctions
- power failures, natural disasters or other emergencies that might compromise appropriate vaccine storage conditions
If requests are approved, the physician-in-charge, vaccine coordinator, or the back-up vaccine coordinator at each site must designated a point person responsible for packing, relocating, receiving, and unpacking vaccine transfers. Each site’s designated point person must be available during the entire vaccine transfer.
Vaccine Orders
VFC vaccine is ordered online using the City Immunization Registry (CIR).Orders are completed using the CIR’s Online VFC Ordering and Management Tool and tracked using the CIR’s Online Vaccine Order Tracking Tool.
The Online VFC Ordering and Management Tool ensures that providers receive an ample supply of vaccine to immunize their patients while minimizing the total number of orders placed by the provider throughout the year; and makes vaccine order recommendations based on the provider’s Doses Administered Report (DAR).
- DAR is the total number of doses reported to the CIR as administered to children eligible for publicly funded vaccines in a 1-year period (numerator) divided by the total number of publicly-funded vaccines distributed to the facility in the same year (denominator)
The process for ordering VFC vaccine online consists of six simple steps outlined below.
Once the CIR’s Online VFC Ordering and Management Tool is accessed, providers must:
- Review vaccine order history
- Confirm, enter or update the following information
- Shipping and storage details
- Refrigerator and freezer temperatures
- Storage used for VFC vaccines
- Enter current VFC vaccine inventory
- Enter replenished vaccine inventory
- Enter VFC order quantities
- Confirm order
- Receive confirmation number
For a step-by-step guide refer to How to Order and Report Vaccines (PDF).
Once a VFC vaccine order is submitted, the program reviews and approves all orders based on a number of criteria:
- Is the provider ordering within their ordering tier (correct part of the month and frequency)?
- Providers are assigned bimonthly, monthly, and quarterly ordering tiers base on an array of factors (e.g., size of practice, number of vaccines administered, VFC population, etc.)
- Is the provider appropriately accounting for VFC vaccine within the CIR? (see Reporting Administered Vaccine Doses below)
- Provider inventory on hand (see Vaccine Management Inventory above)
- Are providers ordering more vaccine than recommended?
- Vaccine recommendations are primarily based on a provider’s DAR and availability of a vaccine safety stock. Secondary factors taken into account are prior ordering history, seasonality, relevant results from site visits, and whether there is adequate vaccine at McKesson for distribution.
Depending on the findings of the review, orders are approved, adjusted, or rejected. If an order is adjusted or rejected, providers are notified of this change by the Vaccine Management Unit (VMU) via phone or email. An explanation of why an order was adjusted or rejected is given at this time as well.
Receiving Vaccine Shipments
The primary vaccine coordinator and the back-up vaccine coordinator are responsible for all vaccine shipments. All VFC vaccine shipments received from the distributor contain heat indicators. These indicators help to establish whether cold chain was compromised during transit to provider sites. The monitors are single-use devices that come in three basic types:
- Those that indicate whether packages have reached temperatures that are too warm (located in outer of box),
- Those that indicate whether packages have reached temperatures that are too cold (located in inner box)
These types of monitors are designed to be irreversible indicators of inappropriate temperatures. The vaccine coordinator and back-up vaccine coordinator are responsible for receiving all vaccine shipments and verifying that vaccine cold chain was maintained during transit to their site. It is important that vaccine cold chain monitors be checked and the temperature inside the transport unit be documented as soon as shipments arrive at your site. The Receiving Vaccine Shipments Checklist must be completed as well. If vaccines were shipped and received appropriately, immediately store them in proper storage units at recommended temperatures.
Please note the frozen vaccines are shipped direct from the manufacturer in specialized boxes that do not contain heat indicators. Immediately upon arrival the vaccine coordinator and back-up vaccine coordinator should go through the Vaccine Shipment to determine the vaccine’s viability. There will be paper work included in the shipment box to address the length of time the vaccines will remain viable during shipping. If that time has been exceeded, upon shipment arrival, you should contact the VFC program. For more guidance on receiving vaccine shipments refer to the CDC Storage and Handling Toolkit (PDF), page 32.