Presentation on theme: "Immunization Best Practices Made Easy"— Presentation transcript:
1 Immunization Best Practices Made Easy Lori E. Hutchinson, BS, MSVaccine ManagerMontana Immunization Program
2 Why another presentation on best practices? Three years of clinic reviews:Nearly 100 facilitiesHundreds of IZ chartsMany different IZ “processes”“We have a hard-to-vaccinate population.”Conclusion:Patterns emerge – same issues over and overNot everyone is familiar with IZ Best PracticesMany clinics are transitioning to EHRsNo forum for exchanging ideasLittle changes can have a big impact
4 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.
5 All clinics are unique!!! Today’s Focus: Will Not Cover: Clinic processes and workflowLittle changes that make a big impactWill Not Cover:Billing/vaccine affordabilityVaccine storage and handlingVaccine administrationPatient/parent/guardian educationAll clinics are unique!!!
6 Getting Them in the Door: SchedulingLeverage reminder/recall functions of imMTrax and/or your EHRTreat all appointments as IZ appointments, even acute care visitsLeverage your scheduling and appointment reminder systems:Schedule next IZ appointments at current visit (as far out as possible)Train schedulers to now minimum intervalsRemind patients to bring IZ records when scheduling and reminding about appointmentsCall and reschedule missed appointmentsVisit PreparationAssess IZ status prior to appointmentGather scattered records and update chart/imMTraxUse forecaster in imMTrax or EHR.Other tools and reference material.Flag charts as due, overdue, or special circumstance (i.e., refusal or hesitancy)
7 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 clinicianGather 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 websiteUse the “Multiple Vaccine” VIS when appropriateManaging VISs through EHR…Must capture publication date and date providedPDF attachment must be current. Consider a link to CDC.
8 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/imMTraxIf no IZ records exist, treat them as unimmunizedReview contraindication and high-risk questionnaireBe familiar with special schedules for high-risk patientsReview previous assessment. Document.
9 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.
10 Avoid Missed Opportunities: Treat every visit as an immunization visitSimultaneously administer vaccines where appropriateFollow valid contraindicationsReview policy on requiring physical examsVaccinate siblings by scheduling appointment at the same time or nurse-only visit upon arrivalKeep patients with valid contraindications or delayed immunizations in the systemMake appointments before they leaveKeep them in scheduled and R/R poolContinue to discuss vaccines with refusing and hesitant parents. Document!
11 Make Vaccinations Readily Available: Make immunizations available at all visitsStanding ordersNurse-only visitsImmunization clinicsNon-traditional office hoursKnow where to refer patients you cannot serve
12 Work Flow: Schedule Remind Gather records Update chart/IIS Assess statusGather recordsUpdate chart/IISRe-assess statusDocument assessment and IZs dueScreen for CI and high-riskProvide VISsReview assessmentReview CI and high-risk screeningAdminister vaccineChart required infoDocument CI, delayed IZsProvide doses admin and doses due info to patientSchedule next visitEnter info in R/R systemUpdate chart/imMTrax
13 Some Themes: Add redundancy: Document: Gather scattered records and update chart/imMTrax.Assess…re-assess…reviewDocument:Doses dueDoses administeredCI, precautions, and high-risk situationsDelays/refusals and reasons why
14 Resources on Immunization Best Practices: Immunization Action Coalition:Clinic resourcesAmerican Academy of Pediatrics:ndards.htmlImmunization Standards of ExcellenceEpidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book):Chapter 3, page 31 “Immunization Strategies for Healthcare Practices and Providers”