Immunization Best Practices Made Easy

Lori E. Hutchinson, BS, MS

Vaccine Manager

Montana Immunization Program

Why another presentation on best practices?

Three years of clinic reviews: Nearly 100 facilities

Hundreds of IZ charts

Many different IZ “processes”

“We have a hard-to-vaccinate population.”

Conclusion: Patterns emerge – same issues over and over

Not everyone is familiar with IZ Best Practices

Many clinics are transitioning to EHRs

No forum for exchanging ideas

Little changes can have a big impact

Immunization Best Practices

High-level Overview: American Academy of Pediatrics Standards of Excellence –

Standards for Child and Adolescent Immunization Practices:

Make vaccination services readily available.

Coordinate vaccinations with other services and provide in “medical home.”

Identify and remove barriers to vaccination.

Minimize patient costs.

Review vaccination and health status at every encounter.

Asses for and follow only medically accepted contraindications.

Educate parents/guardians in culturally appropriate and easy-to-understand language.

Store and handle vaccines appropriately.

Maintain written, up-to-date protocols for administering vaccines.

Continually educate those who administer vaccines.

Report adverse events after vaccination accurately and appropriately.

Today’s Focus:

Clinic processes and workflow

Little changes that make a big impact

Will Not Cover: Billing/vaccine affordability

Vaccine storage and handling

Vaccine administration

Patient/parent/guardian education

All clinics are unique!!!

Getting Them in the Door:

Scheduling

Leverage reminder/recall functions of imMTrax and/or your EHR

Treat all appointments as IZ appointments, even acute care visits

Leverage your scheduling and appointment reminder systems: Schedule next IZ appointments at current visit (as far out as possible)

Train schedulers to now minimum intervals

Remind patients to bring IZ records when scheduling and reminding about appointments

Call and reschedule missed appointments

Visit Preparation

Assess IZ status prior to appointment Gather scattered records and update chart/imMTrax

Use forecaster in imMTrax or EHR.

Other tools and reference material.

Flag charts as due, overdue, or special circumstance (i.e., refusal or hesitancy)

Front Office/Check In/Rooming:

Train front office staff on the basics of contraindications, schedules, and minimum internals. Provide quick reference tools (i.e., imMTrax, online schedulers, EHR).

Ask patients to fill out a contraindication/high risk screening questionnaire prior to seeing the clinician

Gather scattered records from patient and update chart/imMTrax. Insist on written documentation.

Reassess immunization status. Document assessment and IZs due.

Provide current Vaccine Information Statements (VIS):

Consider printing “as needed” from CDC website

Use the “Multiple Vaccine” VIS when appropriate

Managing VISs through EHR…

Must capture publication date and date provided

PDF attachment must be current. Consider a link to CDC.

Assessing Immunization Status:

Train front office staff to preliminarily assess immunization status.

Train several “Immunization Champions” with expert knowledge of schedules and contraindications. If needed, call the Immunization Program for assistance.

Post current childhood and adult immunization schedules and catch-up schedules in all exam rooms, nurses stations, and wherever needed.

Gather scattered records and update chart/imMTrax If no IZ records exist, treat them as unimmunized

Review contraindication and high-risk questionnaire

Be familiar with special schedules for high-risk patients

Review previous assessment. Document.

Charting:

Gather scattered records and update chart/imMTrax.

National Childhood Vaccine Injury Act Requirements: Name of the vaccine

Date of vaccine administration

Vaccine manufacturer and lot number

Name and title of the person giving the vaccine

Address of the clinic where vaccine was given

Publication date of the VISs and date it was provided to the patient.

If immunizations are not given when due, document the reason in the chart (e.g., contraindication, refusal).

Provide to patient simple, easy-to-read list of vaccines administered and vaccines still due.

Avoid Missed Opportunities:

Treat every visit as an immunization visit

Simultaneously administer vaccines where appropriate

Follow valid contraindications

Review policy on requiring physical exams

Vaccinate siblings by scheduling appointment at the same time or nurse-only visit upon arrival

Keep patients with valid contraindications or delayed immunizations in the system

Make appointments before they leave

Keep them in scheduled and R/R pool

Continue to discuss vaccines with refusing and hesitant parents. Document!

Make Vaccinations Readily Available:

Make immunizations available at all visits

Standing orders

Nurse-only visits

Immunization clinics

Non-traditional office hours

Know where to refer patients you cannot serve

Work Flow:

• Schedule

• Remind

• Gather records

• Update chart/IIS

• Assess status

• Gather records

• Update chart/IIS

• Re-assess status

• Document

assessment and IZs

due

• Screen for CI and

high-risk

• Provide VISs

• Review assessment

• Review CI and high-

risk screening

• Administer vaccine

• Chart required info

• Document CI,

delayed IZs

• Provide doses admin

and doses due info to

patient

• Schedule next visit

• Enter info in R/R

system

• Update

chart/imMTrax

Some Themes:

Add redundancy: Gather scattered records and update chart/imMTrax.

Assess…re-assess…review

Document: Doses due

Doses administered

CI, precautions, and high-risk situations

Delays/refusals and reasons why

Resources on Immunization Best Practices:

Immunization Action Coalition: http://www.immunize.org/

Clinic resources

American Academy of Pediatrics: http://

www2.aap.org/immunization/pediatricians/nvacstandards.html

Immunization Standards of Excellence

Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book): Chapter 3, page 31 “Immunization Strategies for

Healthcare Practices and Providers”

http://www.cdc.gov/vaccines/pubs/pinkbook/index.html