1. Immunization Best Practices Made Easy
Lori E. Hutchinson, BS, MS
Vaccine Manager
Montana Immunization Program

2. 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

3. Immunization Best Practices

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 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!!!

6. 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)

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 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.

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/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.

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 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!

11. 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

12. 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

13. Some Themes: Add redundancy: Document:
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

14. Resources on Immunization Best Practices:
Immunization Action Coalition:
Clinic resources
American Academy of Pediatrics:
ndards.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”