1. Reveals Unsafe and Unregulated Practices
SHOT LINE
Reveals Unsafe and Unregulated Practices

2. SHOT LINE Teresa Phillips, RN
Program Manager, Immunizations, Children's Services & International Health Central District Health Department Boise, Idaho (208)
Pam Strohfus, RN, MA
Associate Chair of Academic Affairs
Boise State University
Boise, Idaho 83725
(208)

3. Problem: What Do I Do? Calling Needing advice
Wanting accurate information
Creating individualized immunization schedules
Reporting errors
Requesting how to fix these errors

4. Literature Review 68.7% of children were immunized in 1997
Idaho is ranked 46th in the nation for the 4:3:1:3:3:1 series

5. Literature Review Reasons for errors: Failure to follow protocols
Knowledge deficits
Provider errors increase with newer vaccines
Studies have shown:
10% of immunizations given are erroneous
50% of errors associated with immunizations occurred in administration.
Out of 16,211 children only 9% received immunizations at recommended ages. (Lumin, McCauley, Stokely, Chu, and Pickering. 2002)

6. Errors in Immunization Administration and Storage result in:
Increased the risk of disease
Decreased immunization coverage
Inappropriately stored vaccine resulting in less vaccine availability
Incredibly expensive cost to facility and the client
Cost for vaccine to re-immunize 550,000 children ranges from $10 million to $18 million

7. Plan and Partnership Between CDHD & Boise State University
Identify educational needs
Identify cohort who are the most untrained in immunization delivery and storage
Create change based on knowledge deficits
Educate, educate, educate

8. SHOT LINE Created in 2005 208-321-BABY Increase accuracy of delivery
Decrease lost or wasted vaccine
Identify educational needs
Provide non-confrontational advice
BABY

9. Reason for Calls

10. Credentials of Callers

11. 1st Survey - 2005 Identify Knowledge Base
Overall didn’t think vaccines were medications
70% didn’t know the five rights of medication administration
90% didn’t realize an error occurred until after it happened
38 % didn’t report errors because they didn’t know they made an error
78% didn’t feel needle size was important
Only 55% felt that the seriousness of the incorrect route was very important

12. 2nd Survey- 2006 SHOT LINE Effectiveness
High Satisfaction
Provide supportive non-confrontational education
93% request immunization education
100% feel comfortable in reporting errors
Reduction of errors
7% reported immunization delivery errors in 2005
5% reported immunization errors in 2006
Calls have gone up while the error reporting decreased
Increased “near miss” calls

13. Benefits of SHOT LINE Educational opportunities are being identified
MAs require the most information and education
Errors have been reduced
Operating Costs = $12,000

14. 3rd Survey, Piloted in 2007 Testing Knowledge
Initial pilot tested 10 personnel at a pediatric office
Gave input to produce a better questionnaire
Revised pilot survey then given to 58 MAs in southwest Idaho
Perceived a knowledge deficit was greatest in MAs
The majority of vaccines are given by MAs
Asked specifically about the MMR

15. MMR Survey Respondents
Of 58 MAs surveyed, 38% responded
21.5% responded incorrectly
25-45 % responded inconsistently to questions asking the same question differently
Ascertain between “guessing” and knowledge

16. Specific Questions/ Contraindicated
Can a pregnant teen receive MMR vaccine? (question 13)
77.3% answered correctly (No)
22.7% answered incorrectly (yes)
Is it contraindicated to give MMR to a breastfeeding mother? (question 8)
66.7% answered correctly (No)
33.3% answered incorrectly (yes)
28% had a knowledge deficit in true contraindications
46% formally trained MAs answered correctly
50% of untrained MAs answered correctly

17. Specific questions/storage
If reconstituted MMR is not used it can be refrigerated for 8 hours before it needs to be discarded? (question 6)
91% answered correctly (true)
9% answered incorrectly (false)
When reconstituted, the MMR can be stored at refrigerator temperature? (question 5)
59% answered correctly (true)
41% answered incorrectly (false)
24% had a knowledge deficit in MMR storage
53.8% of formally trained MAs answered correctly,
16.7% of untrained MAs answered correctly

18. MMR Immunization Survey

19. Knowledge Deficit in MAs

20. Assumption 220,000 MAs across the nation (2002)
60% are in medical offices
Give 6-20 vaccines a day on average
Can we assume greater than 30% MAs are under educated?
How does this impact the NIS results
Confident that our national coverage is 76.7%?
Are we really protected?

21. Recommendations for the Future..
Identify “what we don’t know”
In Idaho
Grant funding for statewide education
800 number
Mandate and standardize education
Change legislation to regulate practice of MAs
Duplicate our study nationwide on MAs administering immunizations

22. Acknowledgements Boise State University-Senior Nursing Students
Victor Hernandez, RN, Amber Marsh, RN, Cheryl Suhr, RN, JoRae Thorne, RN, Melissa Blazer, RN, Gaylene Monroe, RN, Amanda Crutchfield, RN, Carissa Baron, RN, Becky Crawford, RN, Angela Morgan, RN, Vicki Williams, RN, Sheri Gates, RN, Taryn Hoffman, RN, Larisa Kogan, RN, Monica Mendoza, RN, Ainoa Autele Douglass, RN, Chantell Nelson, RN, and Rebekah Canfield, RN, Carmen Garnier, RN, & Laura Hein, RN.
Central District Health Department
Cathy Deckys, RN, BSN, Cindy Howarth, RN, BSN, Teresa Phillips, RN

23. QUESTIONS?

24. References
Bird, S. (2006, September). Medication errors: immunization. Australian Family Physician. 35, (9).
Centers for Disease Control. (2006). Epidemiology and prevention of vaccine-preventable diseases. Atkinson, W., Hamborsky, J., McIntyre, L., Wolfe, C., (Eds). (9th ed.). Washington DC: Public Health Foundation.
Centers for Disease Control and Prevention. (2005). Estimated vaccination coverage with individual vaccines and selected vaccination series among children months of age by state – US, National Immunization Survey, A1/2005-Q4/2005 [Data file]. Available from National Immunization program Web site,
Central District Health Department, (CDHD), (2005). Retrieved November 1, 2006 from
Cohen, H. (2001). Shrinking medication errors down to size. Nursing Management, 32, (10).
Cohen, N.J., Lauderdale, D.S., Shete, P.B., Seal, J.B., & Daum, R.S. (2003, May). Physician knowledge of catch-up regimens and contraindications for childhood immunizations. Pediatrics 3, (5).
Denison, A & Pierce, J.R. (2003, January-February). Systems Analysis of a Clinical Error. J Public Health Management Practice. 9(1).
International Council of Nurses. (n.d.). Adverse events following immunization. Nursing Matters. Retrieved march 10, 2007 from

25. References
Lumin, E.T., McCauley, M.M., Stokely, S., Chu, S.Y., and Pickering, L.K. (2002). Timeliness of childhood immunizations [Electronic version]. Pediatrics, 110(5),
Mell, L.K., Ogren, D.S., Davis, R>L., Mullooly, F.P., Black, S.B., Shinefield, H.R., et al. (2005). Compliance with national immunization guidelines for children younger than 2 years, [electronic version]. Pediatrics, 115(2),
Shaw, J., Samuels, R., Larusso, E., and Bernstein, H. (2000). Impact of an encounter based prompting system on resident vaccine administration performance and immunization knowledge. Pediatrics, 105 (4).
Stokely, S., Maurice, E., Smith, P.J., and Klevens, R. M. (2004). Evaluation of invalid vaccine doses. (Electronic version]. American Journal of Preventive Medicine, 26(1),
US Department of Health and Human Services, (DOH). Healthy People 2010: Understanding and Improving Health, (2nd edition). Washington, DC. US Government Printing Office, November 2000.
US Pharmacopeia, Center for the Advancement of Patient Safety, (USP), (2003). Capslink. Medication error analysis: Errors involving vaccines. Retrieved September 13, 2006 from
Varricchio, F. (2002) Medication errors reported to the vaccine adverse event reporting system (VAERS) [Electronic version]. Vaccine, 20(2002),