The Arizona Partnership for Immunization Teaching Process: Best Practices Produce Measurable Results Debbie McCune Davis Jennifer Tinney Kansas City, Kansas March 6, 2007

Annual Trend in Immunization Rates and Well-child Visits, Children Enrolled in AHCCCS (TXIX) Percent

Building Strategic Partnerships: Arizona Immunization Program Office Vaccines for Children AFIX and Assessment Teams Arizona State Immunization Information System (ASIIS) The Arizona Partnership for Immunization Managed Care Organizations Professional Medical Organizations Pharmaceutical Companies

Same Message: Public and Private Sectors Improve and Sustain Immunization Coverage Levels Objectives: Provide training to private and public immunization providers Link private practices into community effort Build immunization team within private practices

Who’s on your Training Team? Coalition Staff or Volunteers: Statewide goals and customer service issues Vaccines for Children Specialists Eligibility,Ordering and storage of vaccines, and Emergency plans Immunization Action Plan Coordinators Value of assessment to improving practice State and Federal Rules and Requirements Public Health Nurse / Local Contact Proper vaccine administration procedures Registry Trainer Hands-on demonstration of registry use Vaccine tracking and reporting

Ready Resources Tools –Training Guide –Educational Materials –Computer –Projector Present a coordinated message from all partners –Improve care as a community –Listen actively for issues /concerns

Trends are positive

Seven Secrets to... Streamlining Immunization Delivery (Remove barriers to quality immunization delivery)

Learn at Lunch Training Track I The Seven Secrets… Customer Service in Immunization Delivery The Arizona Partnership for Immunization (TAPI) Vaccine Handling, Storage and Documentation Arizona Department of Health Services Vaccines for Children Program (VFC) Giving Shots Maricopa County Community Health Nursing Immunization Registry Tips and Tools Arizona Department of Health Services Arizona State Immunization Information System (ASIIS) Lunch Track II More on ASIIS... 12:30-2:30 ASIIS Hands On Training

Program Funding TAPI is contracted by the Arizona Department of health services to deliver the training to statewide immunization provider sites during the summer months. –Qualifies as new provider/staff VFC in-service –Provides registry training for quality reporting Additional funding for lunch and materials provided by grants from the pharmaceutical companies

Trainings are equally distributed for easy access

Seven Secrets… Key messages All practices must capture children’s historic immunization data in order to improve coverage rates of the community Outbreaks will affect you! Last outbreak of measles in Maricopa County was spread in physician offices Working together is the only way to improve outcomes

Training materials

Secret 1 Smile and support parents’ decision to immunize!

Parents are anxious about shots Barriers to on-time immunization Barriers to on-time immunization Parents consider you the expert Parents consider you the expert Help parents keep the entire family and community healthy Help parents keep the entire family and community healthy Have Parent Educationflyersavailable

What can be done to help parents stay on-time Address Safety concerns Answer common questions Hold Catch up clinics Understand the recommended schedule Overcome language barriers Avoid missed opportunities Review records

Protect yourself… Protect your Patients HealthCare Workers need shots too… Yearly flu shot Tdap for Pertussis every 10 years

Secret 2 Set up a routine that supports immunization delivery!

As Part of Your Office Routine Schedule appointments to be age and interval appropriate Schedule appointments to be age and interval appropriate Flag charts of those needing immunizations Flag charts of those needing immunizations Schedule next appointment before parent leaves the office Schedule next appointment before parent leaves the office Make it easy to return for follow up visits Make it easy to return for follow up visits

Use Reminders Implement a system that reminds parents that it’s time for the next shot Implement a system that reminds parents that it’s time for the next shot Dentists and vets do it!

Secret 3 Smart Practices Produce Amazing Results!

Use strategies that work Use accelerated schedule to respond to disease outbreaks Use accelerated schedule to respond to disease outbreaks * Use proper intervals between shots Use catch-up schedule to bring children up to date Use catch-up schedule to bring children up to date Use combination vaccines to complete series on time Use combination vaccines to complete series on time

Daniel T. Cloud Outstanding Practice Award Desert Canyon Pediatrics

What do they have in common? Track immunizations given Enter all shots into ASIIS including historical Provide culturally appropriate education materials to parents Use simultaneous administration and combination vaccines Identify and write down return date for parents (Reminder/recall)

Secret 4 Know your Vaccines for Children Program

VFC Requirements Eligibility screening Documenting and record keeping Vaccine handling and storage Ordering vaccines VFC support services Post Vaccine Administration procedures

Secret 5 Safe Techniques Assure Proper Administration

Vaccine Administration Recommended vaccines New and recently approved vaccines Standardizing injection sites Choosing needle length Therapeutic holding Accurate documentation

Secret 6 Simplify! Use ASIIS Web Application to report, remind, and recall.

Live Demonstration

ASIIS Registry and Web Application Benefits User Friendly User Friendly Query Registry - No Child Should Miss a Dose of Vaccine Due to Lack of Information Query Registry - No Child Should Miss a Dose of Vaccine Due to Lack of Information Easily Adhere to State Reporting Law Easily Adhere to State Reporting Law Generate Reminder/Recall Labels Generate Reminder/Recall Labels Forecasting Forecasting VFC Patient Immunization Log VFC Patient Immunization Log

ASIIS Registry and Web Application Benefits (cont.) Vaccine Inventory Management Vaccine Inventory Management Linkage with EMRs/billing systems Linkage with EMRs/billing systems Export to assessment software Export to assessment software Helpful during events such as Katrina and the Rodeo-Chedeski Fire Helpful during events such as Katrina and the Rodeo-Chedeski Fire Free training and support! Free training and support!

Secret 7 Stay up to date in the ever-changing world of immunizations!

Training Opportunities ASIIS Training ASIIS Training AFIX Assessment AFIX Assessment

Information Sources Federal and State Requirements Parent information and resources

Preparing for an Epidemic or Pandemic Stay advised of epidemics or pandemics by actively checking the Arizona Department of Health Services website Have a plan pre-set so that your office will be ready in any event Contact your local county health department for guidance

Quizzes and Challenges…

Evaluations 95% of attendees increased knowledge of immunization practices 100% indicated intent to make change in practice Comments: “Very motivating for compliance and enthusiasm to work harder to bring children in for their shots”.

Outcomes 270% increase in the number of Arizona providers to reach 90% coverage rates for their 2 year-olds from providers awarded the Daniel T Cloud Outstanding Practice Award in 2005 and 43 under review for THANK YOU!!

What’s Next? Participants request… Updates on new vaccines Information about dealing with adolescents Registry integration with EMR’s Using recall for special populations Outbreaks Understanding the immunization schedule How to handle refusals Discussions about current misconceptions about vaccines

For More Information Visit: