Risk assessment

• Refer to the clinical guidance and information for COVID-19 vaccination providers.
• Undertake a risk assessment of the vaccination site and staffing arrangements, ensuring environmental, health and safety risks are mitigated, by following the basic principles of setting up a vaccination centre and ensuring staff are allocated and trained appropriately. Ideally staff should not provide different vaccines on the same day, and should be trained to check the vaccine, type, volume, age formulation and dose interval carefully to avoid errors.
• Different vaccines must never be stored or used in the same area of a clinic at the same time.
• Update your Standard Operating Procedure (SOP) to include appropriate basic principles and strategies to mitigate risks identified at your COVID-19 vaccination clinic ​that has more than one vaccine brand.

Basic principles

• Use colour coding to distinguish between the vaccines (NSW Health documents are coded blue for the Pfizer (Comirnaty^TM) adult/adolescent formulation vaccine, orange for the COVID-19 Comirnaty^TM (Pfizer) 5 to <12 years of age formulation vaccine, yellow for AstraZeneca (Vaxzvria^TM), green for Moderna (Spikevax^TM) and fuchsia for Novavax (NuvaxovidTM)).
  
• Assign staff for a shift to a particular vaccine clinic – colour coding should be used for staff attire e.g. uniforms or vests.
• Avoid, where possible, running clinics for more than one vaccine brand at the same time. Consideration should be given to holding them on separate days if possible.
• If clinics for more than one vaccine need to be held onsite at the same time there must be separate, clearly defined areas for all aspects of the vaccination clinic flow, including vaccine preparation areas. Clear signs and ground markings should be used to distinguish each area. Staff designated for each vaccine should not be reallocated to the other vaccine on the same shift. Vaccine preparation areas MUST be completely separate.
• Staff should be adequately trained and supervised. Quality control measures and checking processes should be in place including using experienced immunisation teams and clinic supervisors.
• Each different brand/age formulation of vaccine must be transported and monitored separately.

Pre-vaccination clinic

• IT systems should be set up with separate clinics and registration processes for each vaccine brand.
• Ensure that registration systems and consent questions align to the specific vaccine the person is to receive.
• Staff responsible for sending invitations to attend the clinic, entering data and registering individuals should be assigned to one vaccine only.
• Pre-vaccination information provided to the patient should clearly identify which vaccine the person is to receive.
• Information relating to pre and post vaccination care should be specific to the vaccine that the person is to receive.
• When booking dose 2 staff must ensure that the person is registered for the same vaccine/age formulation and apply the correct dosing interval for the relevant vaccine.

Arrival at the vaccination clinic

• Signage at the clinic should clearly direct individuals to the correct area for the vaccine brand/age formulation that they are to receive.
• A staff member should be assigned to assist people to determine which vaccine they are to receive and to direct them to the correct clinic flow accordingly.
• Registration areas should be separated specific to each vaccine.
• Computer systems must be locked to the vaccine portal for the vaccine that the individual is to receive.
• Patients should be given a visible colour coded aid to enable staff to easily identify which vaccine they are to receive (e.g. sticker or arm band – noting that many clinics are also using red identifiers for those with an allergy).
• Registration staff should clearly direct the patient to the appropriate area after registration.

Vaccination clinic

• The clinic area should be divided into separate areas for each vaccine so that the patient flow is completely separate at all times (post vaccination observation areas can be co-shared).
• Different vaccines/age formulations must never be used in the same area of a clinic at the same time.
• The person responsible for administering the vaccine should re-check which vaccine the individual is to receive prior to administration, and that the dose for the vaccine is correct.
• Separate IT portals for each vaccine should be used to ensure that the correct vaccine is recorded for the patient and subsequently transmitted to the Australian Immunisation Register (AIR).
• Patients must be given/directed to the appropriate after-care sheet for their individual vaccine, ideally with written instructions for their second appointment date and time.

Vaccine preparation area

• Each vaccine brand should be stored in separate areas and separate vaccine specific vaccine fridges or freezers (for Pfizer adolescent/adult formulation and Moderna vaccines stored at -15◦C to -25◦C) if possible.
• Fridges and freezers should be clearly labelled.
• If the same fridge or freezer is to be used, the vaccines must be stored in separate areas of the fridge or freezer and must be clearly labelled i.e. different shelves within the fridge or freezer with colour coded signage. 
• Separate preparation areas should be used for each vaccine and must be clearly labelled including colour coding.
• Vaccines must be transferred to the vaccination area in colour coded clearly labelled bags/containers.
• Once the vaccines have been drawn up, they should be transferred to the administration area specific to that vaccine.
• There must be regular clinical oversight to ensure that the correct preparation and drawing up (and dilution as required for the Pfizer (Comirnaty^TM) vaccines) process is being applied in relation to each vaccine, and that the dose and preparation and drawing up process for the relevant vaccine is checked by a senior and experienced clinician at the start of each shift.