Cornell Health Vaccine Inventory Transaction Narrative

Date Created:    April 23, 2024   Last Updated:   April 24, 2024

Overview: 

Cornell Health Nursing offers immunizations to faculty, students, and employees.  Nursing utilizes the PNC system to keep track of all immunizations given.  Reconciliation of inventory occurs monthly.  Additional processes and controls for ordering, storage, and access are in place to protect inventory and to prevent opportunities for fraud or theft.

Criticality:   High

Frequency:   Other

Turnaround:   Other

Key Parties / Contacts: 

Nursing Managers:  Responsible for receiving and verifying count and matching product to packing slips.  Follow up with vendors if errors found. 

Phyle Inventory Control Specialist (PICS):  Responsible for conducting physical inventory counts on a quarterly basis and provides Cornell Health team with final inventory reports.

Cornell Health Finance Staff: Tracks inventory purchases, product disposals and credits in a reconciliation spreadsheet.  Reconciles inventory counts to the general ledger and research discrepancies.

Shared Service Center Staff: Responsible for processing vendor invoices and credits timely and reviewing, validating, and recording inventory adjustment entries.

Key Documents / Sources of Information:

  • KFS GL transactions
  • Invoices and packing slips from vendors

System Access Needed:

Common Problems or Issues Encountered: 

  • Physical inventory count errors.
  • Missing invoices or credits in the GL.
  • Incorrect costing entered.
  • Expired product and waste not recorded in the GL on a timely basis.
  • Disposal of expired vaccines.

Step by Step Procedures:

  1. One of 2 Nursing Managers place an order(s) for items to replenish vaccines that are used.
  2. When orders are delivered, the Nursing Manager that did not place the order checks the items received against packing slips to ensure accuracy. If counts do not match, the Nursing Manager contacts the vendor to request a credit memo or to verify if Cornell will be charged for any product overage received.
  3. Invoices and credit memos are sent to the Shared Services Center (SSC) to be processed and entered into KFS.
  4. Vaccines are stored in refrigerators on level 4 which is accessible to all nursing staff. Some inventory is also stored on level 5 and level 7 in smaller locked refrigerators.  The key to the refrigerator on levels 5 and 7 are kept at the front desk on those levels and only accessible to nursing staff.  The level 4 vaccine inventory storage room is locked outside of operating hours.
  5. When orders are received, items are entered into PNC. Vaccine purchased quantity and cost are tracked on the FYXX GL4701 spreadsheet located U:\Business Service Center\zChad\INVENTORY\FY24 Inventory\Vaccines during the month end inventory reconciliation process.
  6. Vaccines given during patient appointments are logged into PNC on the ticket that is created for that appointment.
  7. To help prevent incorrect vaccines being given, if an incorrect or expired vaccine is taken out of the refrigerator, it will not scan into PNC if it is not the same vaccine that is entered on the PNC Ticket.
  8. Monthly, Cornell Health finance staff follow the Vaccine Inventory Reconciliation process to record cost of goods sold for the month and reconcile the inventory on hand count to the general ledger. Reference Pharmacy Inventory COGS Reconciliation SOP located here:  U:\Business Service Center\zChad\SOPS\SOP Vaccine.
  9. Any inventory variances are researched with the Nursing Manager and any variances are either corrected or adjusted in the monthly COGS entry using Inventory Over/Short object code of 6405.
  10. At the end of each month, the Finance Staff compiles a listing of all vaccines and their most recent cost and forwards to the Billing Manager who updates prices in PNC.
  11. Quarterly, an external inventory control company (PICS – Phyle Inventory Control Specialists) conducts an onsite physical count of RX and OTC inventory.
  12. The Nursing Manager and Cornell Health finance staff verify PICS’s results and research any large variances. If the count is entered incorrectly by the inventory company, the on-hand count is verified and is then fixed by PICS, and the information is updated before leaving the pharmacy.
  13. Any expired vaccines are taken to the Pharmacy and picked up by Inmar quarterly.
  14. Inmar provides the pharmacy with a printout of the inventory taken and handles the disposal of any expired drugs.
  15. Any vaccines prepared but then not given are placed in sharps containers for disposal.  The sharps disposal containers are picked up when full by the custodial staff and taken to be burned.

Key Risks

Key Controls

Inventory could be lost or stolen.

Access is limited to nursing staff.  Financial staff is always present for on-hand count with nursing manger or a member of the nursing staff.

Vaccines in multidose vials can be miscounted.

Doses used are written on a sheet of paper to help with accuracy.  If this is not done, the Nursing Manager estimates the number of doses left in a vial.

Risks of choosing the wrong vaccine.

PNC will not scan an expired vaccine and will not scan a vaccine that does not match what is to be given in PNC.

Risks related to non-licensure of nurses.

Robert Berarducci monitors and tracks licensing and renewals.

Invoices/Credit Memos not sent to AP.

During monthly inventory reconciliation, any invoices not in KFS are sent to Accounts Payable for processing.

Human error for a manually intensive process of recording purchases and inventory counting.

Any variance is compared to the previous month and researched to find and resolve differences.

Metrics:

CH Vaccine Inventory Process Flow Chart