Childhood Immunization Support Program (CISP) Best Practices Summary

Transcription

1 Childhood Immunization Support Program (CISP) Best Practices Summary In February, 2012, CISP asked its IZNews listserv to respond to the following questions based on the National Vaccine Advisory Committee Standards. Below are the results. NVAC Standard #2: How does your practice ensure that, whenever possible, immunization appointments are scheduled along with other appointments, to prevent missed opportunities? Use the State or local registry to check for We try (but are not perfect) to look up each patient in the vaccinations that could be given at each visit. state registry because the forecaster there is better than anything we have in our EMR. In Indiana we have the Children and Hoosiers Immunization Registry Program (CHIRP) registry. Every day we run the CHIRP forecast for every child that is to be seen the next day, no matter the reason. The forecast is given to the medical provider as the provider enters the exam room, and the medical assistants (MAs) are already prepared that there will be vaccines needed. Our staff is required, at every patient encounter, to check the Wisconsin Immunization Registry (WIR). Built into the system is the recommended vaccine schedule which notifies the clinician which vaccine is due when. It is now an expectation that each nurse or MA checks WIR at every patient visit. Keep Patients coming back by scheduling their next visit while they re in the office. Take every opportunity that a patient is in the office to immunize him/her if appropriate. Our computerized registry has a recommend function based on childhood schedule, and this is patient-specific based on the child s age and prior vaccine history, so functions as the standing order for routine vaccination. We make sure patients schedule all needed well-visit appointments on their way out of their last clinic appointment. We also call to remind them of scheduled appointments. We check every time we see a patient if they are up to date. We constantly add on vaccines to other appointments. If you're in the office, you may get immunized - siblings too. We strive to avoid missed immunization opportunities by vaccinating at all visits (provided there is not a precaution/contraindication). Standard work by nursing staff includes use of the child/teen screening questionnaire, and if no precautions/contraindications the child may be vaccinated. Any affirmative answers to the screening questionnaire are referred to the provider for determination of vaccination at that visit. Our sites also offer nurse visits for immunizations only in the event there was a missed opportunity and a child needs catching up.

2 Offer immunization-only appointments to increase accessibility Review patient records to check for skipped or missed immunizations. During school-age immunizations, the nursing staff reviews the child s immunization history with the parents and if they notice that another vaccine could be administered at the current visit to bring the child current, they will encourage the parent to have the child receive it at that time We let the parent know at each appointment when their next visit is scheduled for and when immunizations are due. We encourage parents to schedule appointments for these immunizations. We also offer an immunization-only appointment for parents that have special schedules or when vaccines could not be administered because of a contraindication, such as an illness. The clients in our registry are constantly being reviewed to confirm appointments, and to provide information for which vaccines their children are due. If an appointment is missed, contact is made to reschedule. A note is put in the client s folder to ensure all necessary vaccines are given. NVAC Standard # 7: How does your practice staff communicate with parents about vaccines, in a way that informs them, while also building their trust in the pediatrician? Practice risk communication with the parents. Our office has found that the key is to engage in motivational Some techniques include the CASE model interviewing-type skills. Don't own the patient's decision. ( Listen to their concerns. Ask the family if they would like ns/riskcommunicationvideos.html), and information (that others found useful) in deciding what to do motivational interviewing about vaccinating. ( whatismi.html). Distribute Vaccine Information Statements (VIS). We use the Vaccine Information Statements (VIS) as educational tools for all parents and use face to face Questions & Answers (Q&A) during all well-child visits. Expect to have conversations with parents about vaccines. Don t rush through them, be open and understanding towards parents concerns. Use handouts to help in these discussions, and to answer further questions. Distribute educational information to parents We discuss all vaccines at each visit, we talk about benefits of being vaccinated, the diseases that they prevent, and side effects. We also have handouts, open discussions and address concerns specifically. There are two major clinics for vaccinations in our area. Parents are counseled during both clinics on the vaccinations their children need during this visit and discuss at length any concerns they have regarding them. Additionally, multiple health promotion and awareness flyers have been created in response to needs assessments that were conducted by Public Health Intern Staff, on parent fears. These flyers/brochures have been distributed at health fairs, Health Center clinics, and daycare centers, and will soon be distributed through private physician offices. We have an immunization packet that has a letter from the

3 before the visit on which immunizations will be given Pediatrician encouraging immunizations, another paper stating why you should vaccinate your child, a schedule of when immunizations are due, and the VIS sheets for each vaccine. We give the packet to the parents at the baby s first visit telling them that this is their homework. We talk about starting immunizations when baby is 2 months old. We discuss immunizations again when we take the patient into exam room for the 2 month visit. The doctor then goes over them again during the visit. When we go to administer the immunizations, we ask if there are anymore questions and review what to watch for regarding vaccine reactions. NVAC Standard #10: How was your practice staff trained to understand new guidance for influenza vaccination, and to use the new algorithm for determining how many influenza vaccinations a child needs? Distribute the algorithm to staff, and keep the current version posted where staff can always view it. We posted the algorithm on the wall of the lab. Since it changes from year to year our staff know to look at how things are should be done for the current year. In addition to using Wisconsin Immunization Registry for influenza records, we also distributed a copy of the algorithm that each nurse keeps at his/her desk. We print out the algorithm that is issued by the CDC, and display it in the MAs offices. Have doctors and nurses available to discuss the process and answer questions about the algorithm. Hold a training meeting for all staff Use registries tools/prompts to call for the second dose when necessary Review information from CDC, AAP, and/or vaccine manufacturers I go over the influenza information before each season based on the information that is sent out to our clinic by the CDC and Vaccines for Children Program and review changes and dosages. I also put up the algorithm in our immunization room where we draw up the vaccines. We have an algorithm printed out. We discuss it and answer questions and the doctor and nurse check it every time. Between those two experts, we catch errors. We have an inservice to medical providers and MAs, and finally, CHIRP will call for the second dose if needed. But we always have an inservice as soon as the algorithm is issued. We have an inservice to medical providers and MAs, and finally, CHIRP will call for the second dose if needed. But we always have an inservice as soon as the algorithm is issued. In addition to using Wisconsin Immunization Registry for influenza records, we also distributed a copy of the algorithm that each nurse keeps at his/her desk I go over the influenza information before each season based on the information that is sent out to our clinic by the CDC

4 and Vaccines for Children Program and review changes and dosages. I also put up the algorithm in our immunization room where we draw up the vaccines. Have staff view Webinars We use update alerts from Centers for Disease Control and Prevention (CDC), vaccine manufacturer, and AAP guidelines. Once the regulations for influenza were established, the staff reviewed the written directives, posted the visual algorithm along with the childhood immunization schedule, and attended webinars to reinforce the new policy. NVAC Standard #12: What steps are taken to ensure accurate recording of all aspects of vaccine administration (date, manufacturer, lot number, signature of the vaccine administrator, location it was given, etc.)? Use your Electronic Medical Record (EMR), as it may help prompt you to record all information. Do quality assurance tests by checking charts daily. Develop a form, either for paper charts, or for your EMR, or both, which prompts you for all the information that needs to be documented. Our EMR has a form built in for that. We use the immunization registry with as many items defaulted as possible to avoid possible data entry error. Vaccines received are entered into registry s inventory module including lot number, manufacturer, expiration date, etc., and when the specific lot is selected by the user, all necessary information defaults with it. The date on which the vaccination is given defaults to date of data entry (however may be overridden by user if necessary to document vaccines given a day later in the event of catch up after a mass flu clinic). The user who logs into application defaults as the vaccinator (however again may be overridden if necessary). The VIS form & date defaults to the most current version. Centralized immunization program offices communicate with all sites when VIS are updated and give a 2-week window to update their clinic copies before changing the default in the registry. We chart all vaccine information (lot number, expiration, brand) on the chart note, vaccine record, and state immunization network. We conduct daily checks of or records for accuracy, count doses, and ensure lots and standardization of documentation. We use a paper form that contains all the needed information. Parents are able to sign this form, confirming that they received the VIS statements. Also, we peel off the label on the single dose syringes and attach them to the form. After all the information is put onto the form, the form is scanned into the electronic medical record. We have 2 places where we have to enter the immunizations

5 that are given, our EMR and the immunization registry. We have a single sheet of paper with all the vaccines that we give, with the name of the vaccine, manufacturer, lot number, expiration, dose and site of injection, and route, signature/initials of giver, and VIS dates. At the bottom of the page the vaccines are listed and we circle the ones being given for that day. We have a line below that to write in the patient s name and birth date and registry number. When we draw up the immunizations we double check the vaccine information on the vials, making sure it matches our sheet. We have the parent check that it is the vaccines that they were expecting to receive that day and have them sign the sheet. We use this sheet to enter all info whenever we have time following the appt. It has worked very well for us. I keep the copies filed by month and they have come in very helpful if a question arises regarding immunizations given. Have a specific procedure that is clear to all staff. After all vaccination clinics, a vaccine administration record is completed for all clients. It contains, name of vaccine, dose given (#1 of series, etc), Vaccine manufacturer, lot number, expiration date, signature of administrator, and that a VIS form was given. This procedure is reviewed with all staff, and is part of immunization policy and procedure. NVAC Standard #15: What system does your practice use to ensure that all vaccinations are recorded, and that parents or patients are properly notified when vaccinations are due? Review patient records for missed vaccines, We pull reports of all 2 year olds and then again at age 13. recall those who are missing any. Any that are not up to date are called and encouraged to Maintain procedures and/or proper documentation tools for all steps associated with immunizing a patient. come in to be updated. We have standard protocols for ordering, administering, and recording. We are still struggling with tracking kids who are behind on vaccines and checkups. We lose kids who move a lot. An Electronic Medical Record will help. As written in our immunization policy and procedure manual, a copy of all record keeping forms and instructions are listed to record all vaccines, and the data entry procedure for the New Jersey Immunization Information System is also described. A letter describing needed vaccines are sent to clients with appointment date and time. A reminder phone call is also made 1-2 days prior to clinic date to help insure compliance. We have a single sheet of paper with all the vaccines that we give with the name of the vaccine, manufacturer, lot number,

6 Make use of tools/functions offered in your state s registry expiration, dose, site of injection, route, signature/initials of giver, and VIS dates. At the bottom of the page the vaccines are listed and we circle the ones being given for that day. We have a line below that to write in the patient s name and birth date and registry number. We use this to be sure all the vaccines are recorded. Cards are sent out based on the immunization registry when vaccines are due or past due. We use the reminder/recall function of the registry. We use the immunization network for our state (Arkansas) and verify all vaccines prior to appointments and update the network after all appointments. We use a Reminder/Recall functionality within the registry regarding overdue vaccinations (< 1 y/o receives card if 1 month or more overdue; 1-2 y/o receives card if 2 months or more overdue; school-based health centers receive lists of patients coming due or overdue. This occurs monthly from our centralized immunization program offices and is distributed to immunization champions at the sites. We use an immunization registry throughout our integrated agency (community health clinics, school-based health clinics, inpatient hospital, county public health department) for recording of vaccinations given. Information from our registry is further transferred to the state immunization registry on a daily basis.