Improving the Integrity of the Immunization Cold Chain Process with a Multi-Disciplinary Approach

Background: A May 2010 immunization inventory registry snapshot captured our agency Community Health Services clinics storing an aggregate vaccine inventory of  31,846 doses valued over $1.4 million in VFC and private vaccines combined.  Having experienced occasional vaccine loss due to power outage, refrigerator malfunction or human error at our variety of sites, a standardized process was sought to enhance vaccine storage and handling practices and minimize possibility for temperatures out of acceptable range.     

Setting: Denver Health is a comprehensive, integrated organization serving the city and county of Denver with multiple components including a 500-bed inpatient hospital, Level 1 Trauma Center, the Denver County Public Health Department, and a Community Health Services division with family health centers spanning 8 geographic locations and 13 school-based health centers.

Population: Community Health Services cares for 112,000 patients at family health centers and administered 171,046 pediatric, adolescent and adult vaccinations in year 2009.  School-based health clinics served 8,622 students and administered 14,940 vaccinations during the school year 2009-2010.

Project Description: A multi-disciplinary Task Force with representation from Community Health Services Nursing, Immunization Program office, Biomedical Technology, Engineering, Pharmacy, Communications and Security departments was created.  This Task Force examined current state at our variety of sites, determined target state recommendations, then implemented improvements to safeguard expensive vaccines and is oversighting their implementation. 

Results/Lessons Learned: Agency enhancements include reducing on-hand inventory to 30-45 day supply, standardized alarm response process, biannual alarm response drills by staff at sites, automated reminder for review of clinic responder contact information, and centralized reporting/review of events to evaluate patterns and assess for needed changes system-wide.