The HSE: organising a piss-up in a brewery

peasant

...if only ...at least there they couldn't do no harm by failing.

Because failing is what they are doing ...again!

This time it's about a simple logistical (but kinda important) task like delivering the swine flu vaccine

This is how they said the would and should do it

The HSE is grateful for the support and participation of so many GP Practices in the Swine Flu Vaccination Programme. Deliveries of Pandemrix, the Swine Flu Vaccine, commenced via the usual Cold Chain system this week.

http://www.hse.ie/eng/services/swineflu/vaccine/GP/

This is how the cold chain works (or is supposed to work)
http://www.immunisation.ie/en/Downloads/PDFFile_15098_en.pdf


now ...imagine my consternation when I met the regular parcel delivery guy in Sligo today (company not named for legal reasons) with his quite lukewarm, unchilled sprinter van full of flu vaccine. He's been driving around Sligo all day (43 doctors he mentioned) delivering now well warmed and most likely spoiled vaccine.


But it gets worse ...he was also delivering it to at least three doctors who aren't participating in the vaccination scheme ...more money out the window

A NUMBER of GPs who have opted not to participate in the HSE’s swine flu vaccination programme of at-risk patients yesterday received deliveries of the pandemic vaccine by mistake.

“They are out and delivering this to people that never ordered it. It’s a shambles. There could be a tremendous amount of wastage if people are sent vaccines that they haven’t requested.”

http://www.irishtimes.com/newspaper/ireland/2009/1020/1224257057705.html


So there we have it ...our glorious HSE ...unable to organise a piss-up in a brewery.

Anyone know what the consequences are of getting injected with spoiled vaccine?

spadder

Why does this not suprise me, I'm sure it has to be kept chilled for a reason.

jumpguy

The consequences are that the vaccine might not work. It'd only be harmful if there was any other chemicals.

As far as I know...the vaccine doesn't have to kept cool, only in long-term storage.

EDIT: Nevermind, just read that report. That's pretty...well...it could only happen in Ireland. That's infuriating. I'd call up the HSE if I were you and notify them of this, if you're sure the van wasn't refigerated.

peasant

Recommended procedure following a break in the Cold Chain (2)
•
Any vaccine not stored between 2-8C is no longer a licensed product
•
Do not use these vaccines and return to the National Cold Chain Delivery Service

best case scenario it's just money out the window

Wertz

peasant wrote: »

best case scenario it's just money out the window

They should add that as a motto under the HSE branding logo. Like a method statement of sorts.

The way it's looking we'd probably be better off taking our chances with the damn virus.

magnumlady

It's crazy. Nothing that the HSE does surprises me anymore.

mawk

i successfully organised a pissup for my 21st in the fransiscan well brewery.

Maybe i should take over running the hse?

Elessar

I think you should report this to one of the papers, I'm sure they would run a story on it.

I'm concerned the vaccine I get now will be effectively useless.

phasers

"Right lads, I don't know the set up of this place but I assume it's BYOB"

stepbar

Geez, are these guys so incompetent that they can't even organise a company with chiller equipment to deliver the vaccines? :rolleyes: or even work off the correct list? :rolleyes:

It beggers belief.

peasant

Wertz wrote: »

They should add that as a motto under the HSE branding logo. Like a method statement of sorts.

done


(points at sig)

Biggins

Harneys
Stupid
Executives!

Nuff' said!

Odysseus

Biggins wrote: »

Harneys
Stupid
Executives!

Nuff' said!

I hope you remember to tell them that the next time you require any form of medical,psychiatric/psychological treatment. While the HSE needs be better organised, these type of threads tar all staff including front line staff with the same brush.

I am suprised I even bothered to read this one, as most of the threads I read here tell me that I do nothing for my wages or pension, or the only work I'm interested in or get right is claming expensives.

peasant

Odysseus wrote: »

I am suprised I even bothered to read this one, as most of the threads I read here tell me that I do nothing for my wages or pension, or the only work I'm interested in or get right is claming expensives.

Maybe you can tell us then if this vaccine is supposed to be kept chilled or not?

Am I getting all worked up about nothing?

Biggins

Odysseus wrote: »

I hope you remember to tell them that the next time you require any form of medical,psychiatric/psychological treatment. While the HSE needs be better organised, these type of threads tar all staff including front line staff with the same brush.

I am suprised I even bothered to read this one, as most of the threads I read here tell me that I do nothing for my wages or pension, or the only work I'm interested in or get right is claming expensives.

For the record, I have been fighting/tackling/arguing with them DIRECTLY for the last two years.
On TV, radio, in the newspapers, across office desks and they still are so far out of touch and have their heads stuck up their own backsides, they make Laurel and Hardy look like brain-boxes!

Biggins

peasant wrote: »

Maybe you can tell us then if this vaccine is supposed to be kept chilled or not?

Am I getting all worked up about nothing?

Most vaccines are supposed to be kept chilled within a tight degree range of temperatures.
This even includes the basic ones they inoculate children with like the MMR, etc

Vaccines themselves are a live weaker strain of the danger that is out there that could do more serious damage.
Keeping them chilled stops further cellular growth and division within the object they reside in temp-wise.

Odysseus

peasant wrote: »

Maybe you can tell us then if this vaccine is supposed to be kept chilled or not?

Am I getting all worked up about nothing?

I am psychotherapist so its outside my field, however, my understanding is that the vaccine is in a powder form, water is added prior to use. So I cannot think of any reason why it would need to be kept chilled, however, I am open to correction.

jumpguy

peasant wrote: »

Maybe you can tell us then if this vaccine is supposed to be kept chilled or not?

Am I getting all worked up about nothing?

No, you're not. Done abit of research and the vaccines are meant to be stored between 2 and 8 degrees and then warmed up to room temperature before administration. I dunno what you saw, but are you sure they were uncooled? Did you actually see it? Were the vaccines not in a special box or anything?

wixfjord

Odysseus wrote: »

I am psychotherapist so its outside my field, however, my understanding is that the vaccine is in a powder form, water is added prior to use. So I cannot think of any reason why it would need to be kept chilled, however, I am open to correction.

Nah thats cupa soup your thinking of.

Odysseus

Biggins wrote: »

For the record, I have been fighting/tackling/arguing with them DIRECTLY for the last two years.
On TV, radio, in the newspapers, across office desks and they still are so far out of touch and have their heads stuck up their own backsides, they make Laurel and Hardy look like brain-boxes!

Yes I am somewhat aware of the work you have been involved in, and I can understant the type of walls you must have been hitting, however, as I said you cannot tar us all with the same brush. If we are all idiots it will must sense for you not to attend a hospital for any form or treatment, as your statment implies all HSE staff are "stupid" and I personally would not seek treatment from a professional I deemed to be so afflicted.

opinion guy

Odysseus wrote: »

I hope you remember to tell them that the next time you require any form of medical,psychiatric/psychological treatment. While the HSE needs be better organised, these type of threads tar all staff including front line staff with the same brush.

I am suprised I even bothered to read this one, as most of the threads I read here tell me that I do nothing for my wages or pension, or the only work I'm interested in or get right is claming expensives.

Odysseus I direct you to my previous rant

http://www.boards.ie/vbulletin/showpost.php?p=62746807&postcount=78

Sofiztikated

I'm flumuxed. Seriously. How can a large medical organisation make such a ****up as this!?!

I, in no way blame the delivery guy, he's just doing what he was told, which seems to be a case of

"Here, take this, bring it here, here, here, and for good measure, there, there and if they want some, there."

It'd take some kind of special to think, "Em, does this medical **** have to be kept cold? Nah, just **** it in the outbox, let the delivery guys worry about it"

Sure, why didn't they just post the damn thing out.

Has anybody checked to see if you can get the stuff on eBay? Surely a 4th rate vendor would be able to organise postage over.

peasant

jumpguy wrote: »

No, you're not. Done abit of research and the vaccines are meant to be stored between 2 and 8 degrees and then warmed up to room temperature before administration. I dunno what you saw, but are you sure they were uncooled? Did you actually see it? Were the vaccines not in a special box or anything?

What I did see in the van was a few pink-ish boxes (looked like styrofoam). While they would insulate their contents somewhat, your man had been driving them around all day in a normal van that definetly isn't cooled.
He was also doing normal shipments besides the vaccine delivery (that's how I got to chat to him in the first place, he was delivering something)
Furthermore the local depot (where the vaccine may have been stored overnight) does to my knowledge not have a coldroom either.

having said that ...the vaxine is a compound and needs to be mixed before it gets administered ...maybe the need to keep it cool before mixing isn't that high?
http://www.immunisation.ie/en/Downloads/PDFFile_16219_en.pdf

Odysseus

jumpguy wrote: »

No, you're not. Done abit of research and the vaccines are meant to be stored between 2 and 8 degrees and then warmed up to room temperature before administration. I dunno what you saw, but are you sure they were uncooled? Did you actually see it? Were the vaccines not in a special box or anything?

Out of interest have you a reference for that, I can't understant the temp thing for a powder vaccine.

Odysseus

wixfjord wrote: »

Nah thats cupa soup your thinking of.

Lots of drugs including amps of heroin come in that format, without croutons of course.

Biggins

Odysseus wrote: »

...as your statement implies all HSE staff are "stupid"

Nope - far from it, just Harneys top management executives.

Harneys
Stupid (or Stubborn)
EXECUTIVES

Euro_Kraut

Why would a Doctor accept the vaccine is it was not suitable to administer? Surely they have a responsibility to ensure that they give patients correct immunizations. I am not sure we are getting the full story here.

Biggins

Odysseus wrote: »

...I can't understand the temp thing for a powder vaccine.

A vaccine can come in a bacterial powder weaker safer form.
If its the powder form the OP is pertaining to, it can be just mixed with distilled clean water before application.

peasant

Euro_Kraut wrote: »

Why would a Doctor accept the vaccine is it was not suitable to administer? Surely they have a responsibility to ensure that they give patients correct immunizations. I am not sure we are getting the full story here.

I for one would be quite happy if someone with knowledge and authority on the subject could come on here and tell us that despite all the talk of "cold chain" and "2 - 8 deg C" it is safe to distribute this particular vaxine unchilled.

I might even change my sig back

But until then I can only tell you what I saw and was told.

Odysseus

But now your qualifying your previous statement. Look I understand you point [I think] but the way the media is portarying the HSE at the moment is in my opinion resulting in the general public viewing us all as lazy, greedy and incompetent. I take offense to that, I came accross the thread as I was taking a break from doing some work related research on a Friday night. Not looking for any medals here, but just because I have various degrees and 1000s of hours clinical experience it doesn't mean I don't that to keep my study up. I know I'm not the only HSE member who is doing this, so that takes the lazyness out of the equation.

I was fully aware of the mismangement of the HSE well within my own service inanyway and I think the public should be made aware of it, and staff should be accountable for their roles. However, what I see is a general manipulation of the media that only shows the failures in the system, resulting in the general ill feeling of the public that I metioned above. I may be a member of the HSE and in one sense I am fully in control of how I condut my professional role on a individual basis, but I have tried on alot of occassions to try and change certain practices with my role, and I am severely limited by the organisation on that. To the extent that I no longer offer opinions on how to make the service better, I merely try to offer the best service I can to each patient on a individual basis.

There is a big differece better the HSE organisation and the HSE staff member and this is something that I think is being lost here.

Odysseus

Biggins wrote: »

A vaccine can come in a bacterial powder weaker safer form.
If its the powder form the OP is pertaining to, it can be just mixed with distilled clean water before application.

That what I have been saying, but if it is required to be reconstituted I can't understand the need for it to be kept at a certain temp, once it is reconstituted yes I understand that and that why it has to be used within one hour, if you get my point.

Biggins

Odysseus wrote: »

...There is a big differece better the HSE organisation and the HSE staff member and this is something that I think is being lost here.

I understand what your trying to say.
I wish you well on trying to make the necessary changes.
Where they conflict with political (manipulative?) aspirations, you have a serious up-hill battle.

opinion guy

opinion guy wrote: »

Odysseus I direct you to my previous rant

http://www.boards.ie/vbulletin/showpost.php?p=62746807&postcount=78

portarying the HSE at the moment is in my opinion resulting in the general public viewing us all as lazy, greedy and incompetent

you didn't read it did you.....



Regards vaccine temperature - check the link pandremix mixing insturctions on this page:
http://www.hse.ie/eng/services/swineflu/vaccine/GP/gp.html

At the bottom it says "Once reconstituted Pandemrix® must be used within 24 hours.
Once reconstituted Pandemrix® must be kept at a temperature that is not above 25 degrees.
Should be refrigerated if there is a delay between clinical sessions.
DO NOT FREEZE "

Thou i have to say thats not entirely clear as to whether or not it should be transported on ice or not

Odysseus

peasant wrote: »

I for one would be quite happy if someone with knowledge and authority on the subject could come on here and tell us that despite all the talk of "cold chain" and "2 - 8 deg C" it is safe to distribute this particular vaxine unchilled.

I might even change my sig back

But until then I can only tell you what I saw and was told.

Maybe it a question for the health sciences fourm, they are really the only people to fully answer the question. I have a limited knowledge of various drugs but as I said its outside my professional field

Odysseus

opinion guy wrote: »

you didn't read it did you.....

ok I admit that, tbh I did look at it but its quite a long post and I have very mixed opinions about these threads. I will read it this time.

opinion guy

True. the second half is probably more relevant.

Mrmoe

Do you know for certain that the products were unchilled? If they were in a well insulted container they should be ok especially so if they were in a cooler box or Mr Freeze. The chances are that the vaccine is probably still effective even if warmed up. Generally if some thing is lyophilized you still want to keep it cold due primarily due to denaturation of displayed antigen or vaccine proteins. If it is lyophilized bacteria that have been attenuated then you do not want degradation either which is accelerated at higer temeratures but not entirely elimnated by lower temperatures. Each case will be different and probably will have been studied by the manufacturer.

opinion guy

well forgetting for a minute as to whether this vaccine is affected. what about other things transported by 'cold chain'. is this standard cold chain treatment or are they just saying its cold chain when it isn't ?

Odysseus

opinion guy wrote: »

you didn't read it did you.....



Regards vaccine temperature - check the link pandremix mixing insturctions on this page:
http://www.hse.ie/eng/services/swineflu/vaccine/GP/gp.html

At the bottom it says "Once reconstituted Pandemrix® must be used within 24 hours.
Once reconstituted Pandemrix® must be kept at a temperature that is not above 25 degrees.
Should be refrigerated if there is a delay between clinical sessions.
DO NOT FREEZE "

Thou i have to say thats not entirely clear as to whether or not it should be transported on ice or not

Ok I read it and of course I concur. One point you did miss what the extent of violence we are also exposed to. I used to be part of the HSE critical incident team, it was made up of various volunteers, it was head by one person in occupational health. When he retired he was not replaced, we managed to carry on the service ourself for about one year, but it was to difficult to organise with no body being giving the time to to the admin.

The result one of my team was assualted recently and was sent to a private clinical psychologist, when there could have been a service that cost nothing supplying the same if not better service at no cost.

On the vaccine from what you said it does not say anything about a temp before its reconstituted. I will check your link now.

LookBehindYou

Odysseus wrote: »

But now your qualifying your previous statement. Look I understand you point [I think] but the way the media is portarying the HSE at the moment is in my opinion resulting in the general public viewing us all as lazy, greedy and incompetent. I take offense to that, I came accross the thread as I was taking a break from doing some work related research on a Friday night. Not looking for any medals here, but just because I have various degrees and 1000s of hours clinical experience it doesn't mean I don't that to keep my study up. I know I'm not the only HSE member who is doing this, so that takes the lazyness out of the equation.

I was fully aware of the mismangement of the HSE well within my own service inanyway and I think the public should be made aware of it, and staff should be accountable for their roles. However, what I see is a general manipulation of the media that only shows the failures in the system, resulting in the general ill feeling of the public that I metioned above. I may be a member of the HSE and in one sense I am fully in control of how I condut my professional role on a individual basis, but I have tried on alot of occassions to try and change certain practices with my role, and I am severely limited by the organisation on that. To the extent that I no longer offer opinions on how to make the service better, I merely try to offer the best service I can to each patient on a individual basis.

There is a big differece better the HSE organisation and the HSE staff member and this is something that I think is being lost here.

Well said,, its the pen pushers in the high places in the HSE are to blame, NOT the members of the HSE who do a very good job in their own areas of work.
strange the way none of them are ever held accountable.
I always thought that managerial people get extra wages because of their extra responsibility, BUT this is Ireland, and we are governed by people who set bad examples.

peasant

Well ..here's a presentation from the NHS on Pandemrix & the cold chain.

The presentation is a bit weird, but your man DOES go on a bit about maintaining the temperature and all that

http://library.nhsggc.org.uk/mediaAssets/H1N1/001%20-%20H1N1%20Vaccine%20Storage%20and%20Distribution.pdf

Cold chain
•
The ‘cold chain’ is the system of transporting and storing vaccines within the safe temperature range of 2˚C to 8˚C.
Manufacture
Distribution
Pharmacy
Transport
Practice
Patient

and from here
https://www.northstaffs.nhs.uk/nsPortal/cmsitem?documentPath=NSLib/Swine%20Flu%20Vaccination%20FAQ&version=1

46.
Where can I find details of H1N1 vaccine stability, storage requirements etc? These details will be published in full when the vaccines are licensed. The H1N1 swine flu vaccine will have the same cold chain and storage requirements as the inactivated seasonal influenza vaccines. Typically these vaccines need to be transported and stored, prior to use, in their original packaging at +2C to +8C and protected from light. Further details will be made available before the vaccines are distributed. Please contact your PCT Medicines Management team for details of local vaccine handling and storage policies.

47.
The vaccine has been out of the fridge for 2 hours – can it still be used? See above (Q 42 and Q43 ). Effectiveness can only be guaranteed for the vaccines if they are stored at the correct fridge temperatures (+2C to +8C). Vaccine stored outside the required temperature range are unfit for use and must be marked ‘expired’ and disposed of using set procedures. Heat reduces the potency of the vaccine. Freezing may increase reactogenicity and also reduce potency. As above please contact your PCT Medicines Management Lead for the latest information.

Odysseus

peasant wrote: »

Well ..here's a presentation from the NHS on Pandemrix & the cold chain.

The presentation is a bit weird, but your man DOES go on a bit about maintaining the temperature and all that

http://library.nhsggc.org.uk/mediaAssets/H1N1/001%20-%20H1N1%20Vaccine%20Storage%20and%20Distribution.pdf

Yeah I was struggling to make sense of it myself, but with todays weather in the back of a van, I wonder what the temp would have been. Anyway it back to my book for me and some kip I think.

adamski8

Biggins wrote: »

Keeping them chilled stops further cellular growth and division within the object they reside in temp-wise.

This is not the case, even a quick read of wikipedia will inform you if you dont know the field http://en.wikipedia.org/wiki/Vaccine. In summary most vaccines are modified so they cant cause harm and just cause an immune responce. "live" vaccines are used but they are not harmful (ie they have their toxic elements removed but are still capable of producing an immune responce as the immune system reconises other "parts" of the virus and remembers it next time)

peasant wrote: »

What I did see in the van was a few pink-ish boxes (looked like styrofoam). While they would insulate their contents somewhat, your man had been driving them around all day in a normal van that definetly isn't cooled.

Well firstly they were in styrofoam which is a great insulater and guess what that package contained besides the vaccine....ice/cold packs! This will keep the samples cold for hours if not days!
So the best practice is to keep them between 2-8degrees. What was the temperature outside, probably 10-15. I would doubt this would be a big deal. Slight reduction of potency maybe but I would imagine little. Looking over some literature it seems 15-20% of vaccines are stored at incorrect temperatures and these being in hot countries and not much of an effect on the vaccine. Freezing in transport seems to be a much greater problem and is much more damaging to the vaccines.
I doubt anyone who gets the vaccine will contract swine flu :rolleyes:

tallaght01

Biggins, the information you've given about vaccines is incorrect, and will lead to people getting frightened of them. There is no active pathogenic bug in vaccines.

IN the swine flu vaccine, the only viral particle is a little protein from the surface of the swine flu. Your body sees that when you're vaccinatied, and thinks that, because this protein has entered your system, you must have been infected. Therefore, it mounts an immune response.

With regards to cold chain. The chain starts at the manufacturing plant, and vaccines should always be transported in what are called PBVRs (purpose built vaccine refrigerators).

The effect on the vaccine of a "cold chain breech" depends on the vaccine and the length of time.

It does not, as Biggins implied, allow swine flu to replicate in the vaccine. But it usually means the vaccine is less effective.

This kind of thing is taken extremely seriously in public health units, and if you saw it you should ring your local public health unit and tell them about it. I work in a public health unit and would be very grateful to a member of the public for reporting it.

The HSE is full of gombeens, but I would be AMAZED beyond belief if they didn't have a good cold chain system in place. They've been transporting vaccines around the country for years.

Complaining on boards won't help the situation, so give your local public health unit a call.

Find your nearest one from the list below:

http://www.hse.ie/eng/services/Find_a_Service/Public_Health/

opinion guy

Yes I tihnk thats good advice from tallaght01 - i do think you shoudl inform someone about what you saw

jumpguy

Odysseus wrote: »

Out of interest have you a reference for that, I can't understant the temp thing for a powder vaccine.

Sorry, only saw this today

For Celvapan:
http://www.immunisation.ie/en/Downloads/PDFFile_16217_en.pdf
Page 10 under "Special Precautions for Storage"

Store in a refrigerator (2°C - 8°C).
Do not freeze.
Store in the original package in order to protect from light.

For Pandemrix:
http://www.immunisation.ie/en/Downloads/PDFFile_16218_en.pdf
Page 13 under "Special Precautions for Storage"

Store in a refrigerator (2°C – 8°C).
Do not freeze.
Store in the original package in order to protect from light.

However, its unclear for Pandemrix whether this is before mixing, or after mixing.

Page 13 under "Shelf Life", just before the title "Special Precautions for Storage"

2 years.
After mixing, the vaccine should be used within 24 hours. Chemical and physical in-use stability has been demonstrated for 24 hours at 25°C.

I'd get the impression it's meant to be stored cool before mixing. I might be wrong though, the passage can also be interpreted as if it can be stored in a refrigerator for a prolonged period of time AFTER mixing.

peasant

right ...update:

I rang the dept. of public health in Ballyshannon and was given a number in Sligo to ring.

There I spoke to a Dr. Ryan. The jist of the conversation was that he didn't know about the transport arrangements either, that indeed it would be a concern if the cold chain had been broken, but it may well be that the containers themselves (if not the van) were chilled.
He is going to relay my concern to the poeple who deal with the swine flu vaccine distribution and if he hears anything he will call me back.

He has my name and my number ...I will let you know if and when I have further info.

adamski8

peasant wrote: »

right ...update:

I rang the dept. of public health in Ballyshannon and was given a number in Sligo to ring.

There I spoke to a Dr. Ryan. The jist of the conversation was that he didn't know about the transport arrangements either, that indeed it would be a concern if the cold chain had been broken, but it may well be that the containers themselves (if not the van) were chilled.
He is going to relay my concern to the poeple who deal with the swine flu vaccine distribution and if he hears anything he will call me back.

He has my name and my number ...I will let you know if and when I have further info.

thats would be it!!!!

peasant

adamski8 wrote: »

thats would be it!!!!

It may well be.
It was however my suggestion during the conversation that the containers may have been chilled, the doctor seemed to be of the opinion that normally vaccines would be distributed in chilled vehicles and he was quite stunned at my report that they were being driven around all day in a normal van.

Nichololas

Cleaning up the HSE's ****-ups have been my last 2 summer jobs and paid for trips to France and South America, so I approve of their incompetency.

tallaght01

peasant wrote: »

It may well be.
It was however my suggestion during the conversation that the containers may have been chilled, the doctor seemed to be of the opinion that normally vaccines would be distributed in chilled vehicles and he was quite stunned at my report that they were being driven around all day in a normal van.

I'd be with you on that one.

Fair play to you for calling them. Swine flu vaccine is scarce right now, and it's important to make sure people are not dicking around with it.

Also, if the van wasn't chilled, they won't let GPs give it, so you'll be responsible for a LOT of people not getting ineffective vaccine, so fair play to you.