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Updated VAR.. 16
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FluImmuniza onGuideOverview
Discover Better, Simpler, Faster
The streamlined immunization process has
evolved to adopt a better, simpler, faster
process to drive optimal execution with a focus on
quality and patient experience.
FluImmuniza onGuideTheProcess
FluImmuniza onProcess
Below is the new flu immunization process. In this document, well be
reviewing the key process changes. Any key steps will be highlighted. You
can find the entire SOP in the appendix of this training guide.
FluImmuniza onGuideTheProcess
Step 1: Greet Patient
Remember
If an incorrect PCP is selected, the
patients PNL will be sent to an
unintended recipient. This could
result in a breach of Protected
Health Information (PHI), which is a
HIPAA violation.
FluImmuniza onGuideTheProcess
Step 2: Use Immunization Selection ToolNEW!
The Immunization Selection Tool allows pharmacy team members to enter key information for each
patient and receive a list of eligible vaccines for that patient. This tool will provide you with which flu
vaccines the patient is eligible to receive, depending on the age requirements in your state and
Walgreens policy on vaccination administration.
You can type IMM into your browser OR go to StoreNet > Patient Care > Immunization Services >
Immunization Selection Tool.
Log-in when signing into your IC+ workstation at the start of your shift, so you can easily toggle to
the application when a patient approaches the counter.
Remember
Company policy prohibits
administration of any vaccine, in
any state, to any patient under the
age of 7.
FluImmuniza onGuideTheProcess
Step 2: Use Immunization Selection Tool - NEW!
To use the Immunization Selection Tool:
You must use the tool each time a patient asks for an immunization.
FluImmuniza onGuideTheProcess
Step 2: Use Immunization Selection Tool
Practice Exercises:
Use the following scenarios to practice using the Immunization Selection Tool.
Patient 1
Vaccine
Flu
Prescription Yes
Sex
Male
Birthdate
12/16/2009
Reaction
No
Patient 2
Vaccine
Flu
Prescription No
Sex
Female
Birthdate
9/12/1995
Reaction
No
Pregnant
Yes
Patient 3
Vaccine
Flu
Prescription No
Sex
Male
Birthdate
4/21/1945
Reaction
No
Patient 4
Vaccine
Flu
Prescription No
Sex
Male
Birthdate
1/12/1996
Reaction
No
FluImmuniza onGuideTheProcess
Step 3: Select and Enter the Appropriate Flu Immunization Vaccine in IC+
Remember
In prescriptive authority states, you
will need to search and select the
immunizing pharmacist as the
prescriber.
FluImmuniza onGuideTheProcess
Step 4 : Review Third Party Exceptions
Always review all system quality checks, processor messages and take the appropriate actions:
For all other rejections without the above processor message, the patient may choose to pay
cash for the immunization. If the patient chooses to pay cash, go to the patients 3rd party tab
and enter IMMCASH for both the Plan ID and Recipient ID. Select IMMCASH in the Payment
Information section and resubmit.
10
FluImmuniza onGuideTheProcess
Step 6: Retrieve, Provide and Collect Immunization Documents
1. Retrieve the prescription leaflet and the VAR from the printer and
place the prescription leaflet in the Immunization Ready Tote.
2. Follow hard copy labeling requirements per your state regulations.
3. Retrieve the appropriate Vaccine Information Sheet (VIS) for the flu
immunization.
4. Page the patient to the pick-up window and provide them the VAR and the VIS.
Instruct the patient to review and confirm section A of the VAR for accuracy, complete
sections B thru C for the patient being immunized, and return it to the pharmacy when
complete.
Instruct the patient to review the information on the VIS concerning their flu immunization.
DO NOT complete the POS transaction with the patient until the VAR has been completed
by the patient and reviewed by the pharmacist to ensure the patient is eligible to receive
the immunization.
5. Once the patient returns the completed and signed VAR, the technician should place the VAR in
the Immunization Ready tote along with the prescription leaflet and alert the pharmacist the
patient has returned the VAR.
If the patient has indicated any information in section A is incorrect, update any patientspecific demographic information.
If the PCP is incorrect, update the patients profile with the correct PCP.
6. Inform the patient that the pharmacist will review the VAR to make sure they are able to receive
the immunization and you will page them to return to the pharmacy shortly to complete the sale.
The detailed Flu Immunization SOP is on Page 21 of this document.
11
FluImmuniza onGuideTheProcess
Step 7: Review VAR, Confirm Vaccine Eligibility, & Prep Vaccine
(Pharmacist Only)
12
FluImmuniza onGuideTheProcess
Step 8: Perform 3 Way NDC Match & Complete POS Transaction with Patient
New!
While the pharmacist is retrieving the flu product and performing the 3 way NDC match, the technician
should page the patient to return to the pharmacy and complete the transaction at the POS.
Pharmacist:
1. After validating the patient is eligible to receive the vaccination,
retrieve the vaccine from the refrigerator. Perform a 3 way NDC
match to confirm the correct vaccine is retrieved and complete
question 4 in section D of the VAR. The below items must match:
13
FluImmuniza onGuideTheProcess
Step 9: Confirm Vaccine Eligibility with Patient & Administer Vaccine
(Pharmacist Only)
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FluImmuniza onGuideTheProcess
Step 10: Complete Post Immunization Requirements
Remember
Update the patient record
with any new allergy or
health condition
information.
Vaccine Lot #
15
Immuniza onGuideUpdatedVAR
Using the Vaccine Administration Record (VAR)
The Vaccine Administration Record
16
Immuniza onGuideUpdatedVAR
Using the Vaccine Administration Record (VAR)
The Vaccine Administration Record
17
FluImmuniza onGuideStateSpecificInforma on
State-Specific Information
State-Specific Immunization Policies & Procedures
Immunization Policies and Procedures for your state are available at
StoreNet > Patient Care> Immunization Services > State Specific Information
Use the charts on these pages to find the vaccine administration and dispensing requirements that
apply to your state.
An immunization CANNOT be administered outside of your state specific guidelines, even with a
patient-specific prescription or prescriber authorization.
18
Immuniza onGuideBilling&CashPayments
Billing
Best Practices:
Request and scan every type of insurance card (medical/pharmacy) and/or voucher into the
patients profile
Always attempt to process the claim under the patients pharmacy benefit plan first, if available.
If the patient does not have a pharmacy benefit plan or the claim rejects, request the patients
medical benefit card.
Offer the vaccine at cash price only if every type of coverage rejects.
When billing United Healthcare Medical plans, if you see a Drug Not Covered reject after submitting
to the plan, refer the patient to another provider to get the vaccine administered.
Please ensure the patient is aware of the following: For medical billing, including Medicare Part B,
covered services are not determined at the point of claim adjudication. Walgreens bills medical
plans after the service is provided and Walgreens will send an invoice to the patient for any unpaid
portion.
19
Immuniza onGuideBilling&CashPayments
IMMCASH Processing for Immunizations
To process a cash payment:
If a patient is paying cash, process the immunization under the IMMCASH input code to trigger a system
quality check. This will assist the team member in selecting the appropriate vaccine.
NOTE: This is not insurance or a discount plan.
Follow the procedures below to enter the input code into the patient profile and process cash
immunizations:
Go to the Third Party Plans window on the patient profile and enter the below information.
20
PROCESS DESCRIPTION
DEPARTMENT
AUDIENCE
STEP #
1. Greet Patient
This document provides the steps to process flu immunizations in IC+, administration, and post
administration requirements.
Pharmacy
Pharmacy Team Members
INSTRUCTIONS
A) Acknowledge and greet the patient as they approach the pharmacy.
o Say, Welcome to Walgreens, how may I help you?
B) Determine the patients immunization needs and in IC+, search for and select
the patient receiving the immunization. When needed, register the patient
following the Patient Registration SOP.
C) Ask if there have been any changes to the patients allergies, health
conditions, medication history or insurance since their last prescription fill.
Update this information in the patients profile if applicable.
D) Ask the patient, Would you like us to notify your primary care provider that
you are receiving your flu immunization?
o If the patient states they are not interested or if they do not have a
PCP, proceed to step 2.
o If the patient states yes, follow the steps below.
E) Select Information and go to the Addl Info tab and ask the patient for their
Primary Care Prescriber (PCP).
F) Search for the patients PCP in the Primacy Care Prescriber section. If
needed you can use the patients IC+ profile to locate PCP information or
obtain additional search criteria.
G) If multiple prescribers are found verify the PCPs address with the patient
before selecting the PCP.
o
Remember, the PCP selected is the provider that will receive the
Physician Notification Letter (PNL) for the immunization that is
provided. If an incorrect PCP is selected, the PNL will be sent to
an unintended recipient. This could result in a breach of
Protected Health Information (PHI), which is a HIPAA violation.
If the patient cannot verify the PCPs address when there is more
than one prescriber, do not select the PCP and continue to Step 2.
Walgreen Co.
Page 1 of 6
2. Select and
Enter the
Appropriate
Flu
Immunization
A-B
B) When using the tool, select Flu and enter the patients age, gender,
pregnancy status (if applicable), and ask the patient all additional questions
indicated on the screen and select Submit to determine Flu vaccine eligibility.
o
The tool will inform you all Flu vaccinations the patient is eligible
to receive based on the entered criteria.
If the tool informs you that the patient is not eligible to receive the
immunization, you must consult with the pharmacist.
C) After using the tool to determine the appropriate flu vaccinations for the
patient, enter the immunization in IC+.
D) On the IC+ Patient Entry screen, select Scan, then Flu Vaccine Protocol, and
select the appropriate flu vaccine from the dropdown indicated by the
Immunization Selection Tool.
E) After selecting the appropriate flu product from the dropdown, the product,
quantity, directions, days supply, and refills will automatically populate in the
data entry window and should not be updated.
F) If you are located in a protocol state, the correct protocol prescriber will
automatically populate in the prescriber section of data entry and should not
be updated.
o If you are located in a state where the pharmacist has prescriptive
authority, search for and select the immunizing pharmacist as the
prescriber.
G) Select the correct third party plan from the Type dropdown in the Payment
Information section.
o For assistance billing a third party plan, reference the Immunization
Billing Guide as needed.
o
If the patient is not using a third party plan, enter IMMCASH for both
the Plan ID and Recipient ID in the patients profile in the 3rd Party tab
and select IMMCASH in the Payment Information section.
If the patient does not have a PCP on file, the Patient Info screen will open
and prompt you to enter the patient's PCP information. Since you previously
asked the patient for their PCP information in step 1E, select Save to
continue processing the patients immunization.
Walgreen Co.
Page 2 of 6
3. Review
Third Party
Exceptions
A) If a third party rejection occurs after selecting Fill and Close, attempt to
resolve it by following the Third Party Exception Handling procedures.
B) Always review all processor messages and take the appropriate actions:
o
For all other rejections without the above processor message, the
patient may choose to pay cash for the immunization. If the patient
chooses to pay cash, go to the patients 3rd party tab and enter
IMMCASH for both the Plan ID and Recipient ID. Select IMMCASH in
the Payment Information section and resubmit.
C) If you are unable to resolve all third party rejections, inform the patient and
determine the appropriate next steps.
4. Data Review
and DUR
Review
(Pharmacist
Only)
Walgreen Co.
Page 3 of 6
5. Technician
Retrieves,
Provides, and
Collects
Immunization
Documents
A) Retrieve the prescription leaflet and the VAR from the printer and place the
prescription leaflet in the Immunization Ready Tote.
B) Follow hard copy labeling requirements per your state regulations.
C) Retrieve the appropriate Vaccine Information Sheet (VIS) for the flu
immunization.
D) Page the patient to the pick-up window and provide them the VAR and the
VIS.
o Instruct the patient to review and confirm section A of the VAR for
accuracy, complete sections B thru C for the patient being immunized,
and return it to the pharmacy when complete.
o Instruct the patient to review the information on the VIS concerning
their Flu immunization.
o DO NOT complete the POS transaction with the patient until the
VAR has been completed by the patient and reviewed by the
pharmacist to ensure the patient is eligible to receive the immunization.
E) Once the patient returns the completed and signed VAR, the technician
should place the VAR in the Immunization Ready tote along with the
prescription leaflet and alert the pharmacist the patient has returned the VAR.
o
If the PCP is incorrect, update the patients profile with the correct
PCP.
F) Inform the patient that the pharmacist will review the VAR to make sure they
are able to receive the immunization and you will page them to return to the
pharmacy shortly to complete the sale.
o
6. Review VAR
to Confirm
Vaccine
Eligibility
(Pharmacist
Only)
B) Confirm vaccine eligibility based on the patients age, the answers provided
on the VAR in Section B using the VAR screening procedures.
o
A
B
C) Review Section C of the VAR to validate the patient signed and dated the
form.
C
Walgreen Co.
Page 4 of 6
D-F
I)
7. Prepare and
Administer
Vaccine
(Pharmacist
Only)
After the POS transaction has been completed, instruct the patient to have a
seat in the waiting room and inform them the pharmacist will be right with
them to administer their immunization.
A) Gather the needed supplies to administer the vaccine and place them in the
Immunization Tote.
o Epi-Pen(s), gloves, alcohol pads, bandage, and cotton balls
B) Use aseptic technique to prepare the vaccine with the appropriate syringe or
needle tip. Return the multi-dose vial to the refrigerator or if no additional
doses remain and vial is not completely empty, dispose of the vial following
the Hazardous Waste Policy and Procedure if applicable.
C) Bring the patient receiving the vaccine to the designated private immunization
area along with the needed immunization supplies and a sharps container.
D) Confirm the correct patient was brought to the private immunization area by
asking the patient to confirm their name and date of birth.
E) After confirming the patients name and date of birth, confirm with the patient
the type of vaccine they are there to receive.
o Say, [Patient name], just to confirm, which vaccine are you here to
receive today?
Walgreen Co.
Page 5 of 6
F) Review the screening questions on VAR with the patient and confirm vaccine
eligibility.
G) Ensure the VIS was provided to patient and ask them if they have any
questions concerning the vaccine.
H) Complete questions 1 thru 3 in Section E of the VAR DURING the patient
interaction.
I)
J) Complete Section F of the VAR and circle the site of administration AFTER
vaccine administration. Clearly print your name and sign the VAR to indicate
you administered the vaccine to the patient.
K) Instruct the patient to remain in the area for approximately 15 minutes for
observation to monitor the patient for post immunization adverse reactions.
If the patient has an adverse reaction, follow the emergency protocol
produces.
L) Thank the patient and return to the pharmacy with all of the immunization
supplies, including the sharps container. Ensure you leave the immunization
area clean, neat, and organized.
M) Hand the completed VAR to the technician for post-immunization
documentation requirements.
o
8. Complete
Post
Immunization
Requirements
A) It is required to enter the Vaccine information and scan the VAR as soon as
possible after the administration of the immunization to ensure compliance
with regulatory requirements.
B) Review the VAR and update the patient record with any new allergy or health
conditions.
C) Scan the barcode on the top right corner of the VAR using the IC+ barcode
scanner to automatically locate the patients immunization in the work queue.
o
If you are unable to use the IC+ barcode scanner, use the patient
name on the VAR to locate the patients immunization in the work
queue. Once the correct patient has been found, highlight the
immunization in the work queue and select Options >>Vaccine Info.
D) Use the information documented in Section D and F of the VAR, to enter the
following information:
o Vaccine Lot #
o Vaccine Exp. Date
o Vaccine Administration Site
E) Press Alt + V to select Add VAR and scan the completed VAR into IC+.
F) Press Alt + O to select OK to complete IC+ immunization documentation.
G) File the scanned VAR in the Immunization Record Keeping System.
Walgreen Co.
Page 6 of 6