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2011 Model Practice Application (Public)
Application Name: 2011 Model Practice Application (Public) : Florida Department of Health in Broward County : Connecting the “dots” between Public Health Preparedness and Prevention during a Pandemic.
Applicant Name: Dr. Paula M. Thaqi, MD
Connecting the “dots” between Public Health Preparedness and Prevention during a Pandemic.
BROWARD COUNTY HEALTH DEPARTMENT
Connecting the “dots” between Public Health Preparedness and Prevention during a Pandemic.
Responsiveness and Innovation
In the fall of 2009 Broward County, Florida, along with the rest of the nation was called upon to provide H1N1 vaccine to priority groups as determined by the Centers for Disease Control (CDC). The World Health Organization (WHO) alert level was at Phase 6 "pandemic." The pandemic (WHO level 6) status was based on geographic distribution and not the severity of Swine flu. Swine flu H1N1 was circulating world-wide. CDC stated that the H1N1 virus was causing illness, hospitalizations and deaths in the US during the normally flu-free summer months. Activity was increasing in the Southeast United States. The groups recommended to receive the novel H1N1 influenza vaccine included all people from 6 months through 24 years of age. Broward County took this as a call to action to provide in-school vaccinations
Agency Community Roles
The BCHD was the lead agency in this practice. BCHD provided the Incident Command Structure. The Operations, Planning and Logistics sections helped to coordinate the in-school vaccinations. Existing nursing staff, along with temporary staff conducted pre-screening of all consent forms.
Costs and Expenditures
In the fall of 2009 Broward County, Florida, along with the rest of the nation was called upon to provide H1N1 vaccine to priority groups as determined by the Centers for Disease Control (CDC). One of these priority groups included school age children. The Broward County Health Department (BCHD) in partnership with Broward County Schools (BCS) launched a major vaccination campaign that included in school closed vaccination Points of Dispensing (PODs). The Broward County School system is the 6th largest in the nation with 229 public schools and 51 charter schools with over 255,000 children. There are also178 private schools in Broward County. BCHD approached this challenge by utilizing an Incident Command structure (ICS) and by collaborating with Broward County Public School’s to provide H1N1 vaccines during school hours. The ICS was activated in August, 2009 and the in-school vaccination campaign began October 19, 2009. The goal of the campaign was to vaccinate as many children age 19 and under in Broward County. The objective was to provide an in school vaccination campaign to vaccinate as many children, age 19 and under, in a school setting to reduce morbidity and mortality related to H1N1. BCHD succeeded in pre- screening over 145,000 H1N1 consent forms and providing 142,164 H1N1 vaccinations, first and second doses. To further expand the success of the campaign, in-school vaccines were also provided at private schools, pre-school venues and foster child care sites. Discussions were held with Broward County Schools as to the benefit to the Public Health System and Schools to children being vaccinated for H1N1. This discussion led to a School Board vote on October 6, 2009 which allowed the BCHD to begin an in school vaccination campaign. At that time the BCHD expanded the ICS structure to include a POD Management Unit with Public, Private and Charter and Child Care Center divisions under the operations section, to account for this process. Logistical and financial resources were then determined. As part of the expanded ICS structure, BCHD staff members were identified to assist with the implementation. An agreement with a nursing staffing agency was also executed to supplement vaccination and clerical staff. A documentation division was also developed to immediately develop consent forms in four languages. Consent forms and vaccine information statements were delivered to each school by the distribution unit under logistics, in order to obtain parental consent. Upon consent the distribution division picked up the forms for pre-screening by the POD management division to determine the appropriate type of H1N1 vaccine needed for each child. The planning section developed a weekly in school vaccination schedule, which included the projected number of days at each school, staffing needs per school (determined by student population and an estimated 50% consent rate) and number of vaccines needed. The public school unit assigned a nursing team, a clerical staff person, and a school vaccine liaison (SVL) to manage the in school vaccination POD. Supplies, other than syringes and vaccines, were prepositioned by the distribution unit at the school site at least one day in advance of the vaccinations beginning. In-school vaccinations were accomplished at all public schools and charter and private schools that agreed to participate. The specific factors that led to the success of this project was the collaboration and cooperation of Broward County Public Schools to allow the BCHD to provide in school vaccinations and the extensive staffing by a Nursing Agency to assist with pre-screening all vaccine consent forms. BCHD also conducted outreach to all Charter and Public schools which afforded them the same opportunities as the Public Schools for in-school vaccinations. The earmarked funding availability from the Federal Government provided the BCHD the opportunity to provide both ample supply and staff.
To meet the goals and objective of the practice the following tasks were completed:
Pre-vaccination: Met with school staff to agree to mass immunizations, obtained School Board approval, hire and trained temporary staff for school immunizations, train School Point of Dispensing (POD) staff, printed distributed and collected consent/screening form packets in four languages, medically screened consent forms, continued to coordinate with School Board staff, implemented a dedicated H1N1 information phone line for parents to call.
Implementation: Continued to print, distribute, and collect consent/screening form packets in four languages, medically screened consent forms for the first week’s vaccination, continued to coordinate with School Board staff, fully activated Incident Command Center for mass vaccination campaign, planned private and charter school vaccinations/meetings, continued school vaccine clinics, increased capacity of Parent Hotline for questions regarding “in school” vaccination, provided “open houses” to assist with consent form completion in selected schools.
Second doses: Implemented “2nd dose” phase of School Vaccination Campaign in scheduled schools utilizing the previously mentioned process.
The time frame for the tasks began in October, 2009 and ended in January, 2010
This practice can be replicated as an incident of this magnitude occurs, i.e. the need to vaccinate many children in a short amount of time. This structure would be utilized again in the future due to the success, should the need arise. Stakeholders of this project, Broward County Public Schools (BCPS), have demonstrated their commitment to perpetuate this practice as they have permitted Broward County Health Department (BCHD) to provide other vaccines within the school setting since this practice.
As this practice was in response to a Pandemic it will not be sustained. However, the lessons learned in this project, the use of an ICS structure and pre-screening consent forms has been used since the end of H1N1. At the end of the 2009-2010 school year BCPS allowed the BCHD to provide in-school TDAP vaccinations to students who would be entering seventh grade in the following year. The same process was used as with H1N1. Students received consent forms ahead of time, consent forms were pre-screened and BCHD nurses went to the schools and provided vaccinations. An ICS structure was in place during this practice. During H1N1 BCHD succeed in communicating the importance of a government public health program.
Outcome Process Evaluation
The objective was to provide an in school vaccination campaign to vaccinate as many children, age 19 and under, in a school setting to reduce morbidity and mortality related to H1N1. The following performance measures were used to evaluate the practice. Epidemiology: # ICU Hospitalized, # Pregnant Hospitalized, # Deaths, # Probable Cases, # Negative Cases, # Total Cases, # Outbreaks Under Investigation School/POD Vaccination Campaign: # Number of schools being vaccinated, # of Students Vaccinated, # of Primary Vaccinations, # of Secondary Vaccinations, Total Students Fully Vaccinated, % of projected Students fully Vaccinated, # of Vaccinations per hour, # of Vaccinations per Nurse per Hour, Total school visits for the operational period, Vaccinations given, all types, previous operational periods (cumulative), Total Vaccinations given, all types, this operational period, Total Vaccinations given, all types, to date (schools only) Health Dept Operations (BCHD): # of BCHD staff deployed or involved in some type of H1N1 activities/commitments, # of BCHD services/units that are partially functional, somewhat reduced or are not at full capacity, # of BCHD services/units that have completely suspended normal operations Tactical Communications / IT: # of H1N1 Related Calls to Call Center, # of Hits to BCHD Website, # of Web Downloads, # of Website Updates Ground Unit: # POD Kits delivered, Total # Deliveries made Data was collected through the use of multiple reporting vehicles through a central collection point in the situation unit. POD data was gathered utilizing a daily reporting log by POD Leaders/SVLs and submitted to the situation Unit Leader for recording and analysis and reporting. The vaccination campaign reporting was completed utilizing a 9-step reporting process initiated through weekly section meetings. Each unit leader would report the results of that week to the Section Chief. These results were recorded by the documentation unit personnel who in turn submitted the data through a structured report online via a situation report drop folder located on the BCHD’s network. Incident Management Team (IMT) meetings were held every Friday with all section chiefs for planning and data communication. These meetings, led by the Incident Commander and the Planning Section Chief was a forum where each section leader reported the status of the previous weeks Incident Action Plan activities assigned to that section. Initially data was only reported through the IMT meetings. The labor intensity of recording all of the data live at the meeting was extremely challenging for the documentation unit. Adjustments to the reporting system resulted in the previously mentioned process. As a result of the daily reporting logs from the POD Leaders/SVLs adjustments were made to staffing and supply levels. For example, as daily log reports were recorded and analyzed, a comparison to the projected total vaccinations for that school was conducted. If the rate vaccinations per nurse per day was found to be higher for one school than others; nursing personnel and supplies were shifted the next day to meet the established goals at the other sites. It was this rapid cycle analysis and improvement that enabled the success of the vaccination campaign and the achievement of the projected timelines To meet the goals and objective of the practice the following tasks were completed: Pre-vaccination: Met with school staff to agree to mass immunizations, obtained School Board approval, hire and trained temporary staff for school immunizations, train School POD staff, printed distributed and collected consent/screening form packets in four languages, medically screened consent forms, continued to coordinate with School Board staff, implemented a dedicated H1N1 information phone line for parents to call. Implementation: continued to print, distribute, and collect consent/screening form packets in four languages, medically screened c