1. Extreme Makeover Vaccine Ordering and Delivery Optimization Brandon Rector MSW Customer Service Supervisor NC Immunization Branch Helen T. Kuykendall Public Health Analyst, Immunization Services Division Vaccine Supply and Assurance Branch Immunization Services Division, NCIRD, CDC

2. Course Outline • Provider Survey Results • What happens when you order vaccine? • Minimizing Lost Vaccine • How to Receive Vaccine • Allocated Vaccines (Hib, Pentacel, influenza vaccine, hepatitis B vaccine) • Common Causes for Delay • Tips & Tricks for Optimizing Your Order

3. What Do You Think? • “I would like to see decreased time between ordering and delivery.” • “Please increase the timeliness once an order is placed.” • “When we use McKesson as a wholesaler, we get the vaccine next day. Why does it take two weeks for state orders to arrive?” • “Returning boxes is impossible. Boxes are bulky and are often not picked up for weeks.”

4. What Do You Think? • “Supply must meet demand. We have had shortage after shortage despite ordering vaccines. The interruptions in the chain from company to state to office to patient must cease. It is a nightmare to keep track.” • “Vaccine shipments were delayed in the fall and orders were received in individual shipments rather than collectively. Is the state being charged for each shipment?” • “We have concerns with errors in the lot numbers of vaccines that we have received.”

5. The Ordering Process Orders come to Raleigh

6. Orders submitted to CDC for approval

7. CDC sends orders to McKesson Specialty

8. McKesson Specialty sends vaccine to provider/data to Raleigh

9. McKesson Distribution Process

10. North Carolina Monthly Volume - Doses

11. Ways you can minimize vaccine loss • Open and inspect all vaccine shipments immediately ColdMark™ Freeze Indicator Warm Mark • Call877-TEMP123 (877-836-7123)or your State program office if you have questions about vaccine viability within 2 hours of receipt

12. Ways you can minimize vaccine loss • Office Closure • Ideally do not place orders that will arrive when your office is closed • Communicate any planned office closures with the State program • Do NOT work directly with the carrier • Order Refusal • Do NOT refuse vaccine shipments • Even if you think you cancelled an order • Contact your state program

13. Receiving Vaccine • Does everyone in your office know who to contact when vaccine arrives? • Open and inspect all vaccine packages immediately. • What does inspect mean? • Put vaccine into refrigerator/freezer • Accept your Inbound Transfer in NCIR. QUILT

14. QUILT • Quantity • Integrity • Lot/Expiry • Temperature

17. Allocated Products • PedvaxHIB • ActHIB • Pentacel • Fluzone • FluMist • Fluvirin • Recombivax-HB • Engerix-HB • H1N1? • Limited Supply • Production Shortages • Outbreaks • Pandemics

18. How Do You Allocate Vaccine to 1300 Hungry Providers? • Order-Driven Process • Most vaccines are allocated monthly • Provider orders are shipped weekly Why is it so difficult to predict the amount of vaccine needed from week to week?

21. What Is Holding Up That Vaccine? • Providers • NC Immunization Branch • CDC • McKesson

22. Beyond Your Control • Data entry errors • Allocation management • Change of contracts (3X/year) • Holidays • Handling errors

23. Winning Strategiesfor Providers • Are ordering the suggested amount? • How often are you ordering? • What day are you ordering? • What are your hours?

24. Course Outline • Provider Survey Results • What happens when you order vaccine? • Minimizing Lost Vaccine • How to Receive Vaccine • Allocated Vaccines (Hib, Pentacel, influenza vaccine, hepatitis B vaccine) • Common Causes for Delay • Tips & Tricks for Optimizing Your Order

25. Thank you!Brandon Rectorbrandon.rector@ncmail.net 919-707-5553NC Immunization Help Deskncirhelp@ncmail.net 1-877-873-6247