Childhood Practice Tools
Getting Started – Suggestions to Improve Your Immunization Services
The first step to improving vaccination coverage for your patient population is to orient the entire practice (clinicians and support staff) to prioritize vaccines.
Have a meeting to discuss and identify any barriers to vaccination in your patient population and collectively formulate plans to minimize such barriers.
As a group, take inventory of current vaccination practices in your office with this tool from the Immunization Action Coalition.
Review the results with everyone in your practice setting, and identify opportunities for improvement.
When you have selected a specific focus for practice change, define each team member's role and responsibility in making the necessary adjustments to your immunization practices. Depending on your needs, you may require the involvement of colleagues with IT expertise.
Consider the following:
- Are there ways that you can improve your current documentation of vaccinations? Are vaccination records accurate and easily accessible? Is vaccination information entered into an immunization information system (registry)? Who is responsible for documenting vaccines received in other settings, patient/parental refusal or contraindications?
- Determine who will be responsible for proactively reviewing the vaccination status of your patients at each patient visit, including assessing for contraindications. Are there clinician reminders about vaccinations in medical records?
- Designate a 'vaccination champion' to establish standing orders for immunizations. Identify the vaccines that you would like given under standing orders. Download materials for vaccine-specific standing orders from the Immunization Action Coalition Web site (http://www.immunize.org/). Provide appropriate training for those individuals who will be giving the vaccinations. Establish the appropriate process for screening for contraindications, providing patients with Vaccine Information Statements, documenting vaccines administered, managing medical emergencies, and reporting adverse reactions to a vaccine.
- Develop and implement a reminder/recall system based on charts or an electronic information system to contact patients who are due or past due for vaccinations. Utilize current technology such as email or text messages to reach patients/parents.
- Identify ways to expand opportunities to vaccinate by extending office hours or having drop-in vaccination services.
- Establish resources to educate patients/parents about vaccines and enhance discussions about the benefits and risks of vaccinations.
The Institute for Healthcare Improvement (IHI.org) has a number of resources for performance improvement projects. Register to use the site (free and easy), and download a Plan-Do-Study-Act Worksheet to assist in your plans to improve vaccination rates in your practice.
Model for Improvement Video
Along with your plan for improving your immunization services, we want you to be successful at implementing that plan. The Model for Improvement is one methodology for approaching change that is used in a variety of settings, including health care. This 11-minute video describes the methodology for you and your team. Family physicians illustrate how they applied this methodology to their own practices with successful outcomes.
Facilitate Access to Current Immunization Information
Bookmark the CDC Vaccines and Immunization Home Page
Staying current with immunization schedules and recommendations can be challenging. Many resources are available online and/or through email updates. Bookmark the CDC Vaccines and Immunization home page on office computers and engage everyone in the care team to obtain and share up-to-date immunization information.
Current Immunization Schedules
The current immunization schedules for all age groups are available for download and printing from the CDC. Ensure that all providers agree on the schedule(s) and post the current age-appropriate immunization schedules in all exam rooms in your practice.
Summary of Recommendations for Child and Teen Immunizations
The Immunization Action Coalition has created a summary of recommendations for child and teen immunizations. This summary includes catch-up information as well as contraindications and precautions.
The Society for Teachers of Family Medicine Group on Immunization Education has developed an app for iPhone/iPod, iPad, Android, Blackberry and PC that includes the childhood, adolescent, and adult immunization schedules for the US, and vaccine-specific information such as high risk indications, adverse reactions, contraindications, catch-up, administration, risk communication, and epidemiology.
http://www.immunizationed.org or http://itunes.apple.com/
Email Updates from the CDC
Sign up to receive a variety of publications including Morbidity and Mortality Weekly Report, and updates from the CDC. This is an excellent way to stay current with immunization recommendations, developments from the Advisory Committee on Immunization Practices (ACIP), and related issues.
Click on "Get Email Updates": http://www.cdc.gov
Email Updates from the Immunization Action Coalition
Subscribe to free email news service and periodicals from the Immunization Action Coalition. This is another excellent way for all members of the care team to stay current with vaccine recommendations, licensures, and other immunization information.
Sign up for additional immunization-related email news services from other organizations at:
Red Book® Online Vaccine Status Table
The American Academy of Pediatrics (AAP) provides current information on vaccine licensure and AAP recommendations about vaccines in the Red Book® Online Vaccine Status Table. This can be downloaded as a printable PDF or bookmarked for easy access on computers.
FDA Licensed Vaccines
The FDA maintains a current list of vaccines licensed for immunization and distribution in the US. Included in the supporting documents are current package inserts, information on approvals, and new indications. Bookmark this page for easy access.
Vaccine Information Statements (VIS)
Vaccine Information Statements (VIS) are available from the CDC and the Immunization Action Coalition in numerous languages.
The national vaccine safety surveillance program (Vaccine Adverse Event Reporting System - VAERS) is co-sponsored by the CDC and the FDA. VAERS collects information about adverse events that occur after the administration of vaccines licensed for use in the United States. All vaccine providers should be knowledgeable about this surveillance program and the mechanism for reporting adverse events.
Strategies to Increase Immunization Coverage
Task Force on Community Preventive Services Recommendations
The Task Force on Community Preventive Services recommendations and findings regarding interventions to increase vaccination coverage in children, adolescents, and adults are available through the Community Guide Web site.
AAP Policy Statement-Increasing Immunization Coverage
In 2010, The American Academy of Pediatrics published recommendations for pediatricians (individually and collectively) to improve immunization coverage of children.
Use of standing orders is an evidence-based strategy for improving immunization rates. Standing orders are written authorizations by physicians that specify criteria for vaccine-eligible patients (for each vaccine), and allow eligible nurses and other health care professionals to screen and vaccinate appropriate patients per protocol. Engage the entire care team in the implementation of standing orders and increase vaccine administration efficiency and reduce missed opportunities for vaccinations.
Standing orders can be obtained from the Immunization Action Coalition.
Patient Reminder and Recall
Patient reminder and recall for immunizations that are due or overdue are effective interventions for improving immunization rates. Reminders can be via multiple means including mail, telephone, and email.
Extending hours for working parents, drop in "shot-clinics," and other efforts to make it easier for parents to bring in their children for immunizations can help to increase immunization coverage in the pediatric patient population.
Immunization Information System (Registry)
Participate in an Immunization Information System (registry). Obtain information from the CDC and specific contact information for your state.
Provider Assessment and Feedback
Establish a performance feedback process to monitor immunization rates in your patient population. If you participate in an immunization registry, it may be possible to use this system to check the immunization rates in your practice. Assessment, Feedback, Incentives, and Exchange (AFIX) and Comprehensive Clinic Assessment Software Application (CoCASA) through the CDC are designed to assist providers in assessing their immunization practices.
Performance Feedback: http://www.cdc.gov
Strategies to Enhance Immunization Practices
Vaccine Administration: Making the Process More Efficient in Your Practice
This publication by Barry L. Hainer (Fam Pract Manag. 2007;14:48-53) provides suggestions for optimizing your immunization process.
Immunization Barriers and Solutions
This paper by Ilene Burns and Richard Zimmerman (J Fam Pract. 2005;54:S58-S62) provides insight into immunization barriers and solutions for improving immunization rates
Ensure that a comprehensive vaccine record is present and in a visible location in each patient's chart. Download the Vaccine Administration Record for Children and Teens from the Immunization Action Coalition. Be sure that all patients have their own immunization record as well.
Use a screening questionnaire for improved efficiency. Download the Screening Questionnaire for Child and Teen Immunization from the Immunization Action Coalition.
Educate staff on valid and invalid contraindications for vaccines. Use the Guide to Contraindications and Precautions to Commonly Used Vaccines from the Immunization Action Coalition or the CDC's Quick Guide to Contraindications & Precautions to Commonly Used Vaccines.
For children who are behind on vaccinations or started late, use the Catch-up Immunization Schedule for Persons Aged 4 Months through 18 Years from the CDC.
Or access through SHOTS: http://www.immunizationed.org
Notification of Vaccination Letter
Document the immunizations that you give in each patient's vaccine record in their medical chart. When immunizations are received outside of your practice, it is important to obtain accurate vaccine documentation from alternate providers. A downloadable and printable letter for this purpose is available from the Immunization Action Coalition.
Coding for Vaccines and Administration
The American Academy of Family Physicians (AAFP) has a resource page with current information related to billing for vaccines.
The AAFP website includes many useful links and resources related to immunizations.
Effective Communication about Vaccine Benefits and Risks
Dr. Marshall webinar "Addressing Parent's Concerns about Vaccines"
Click Here >>
Dr. Grogg standardized patient video "Immunizations for a Two-Month-Old and Vaccine Safety Concerns"
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Dr. Marshall and Dr. Campos-Outcalt Peer-to-Peer dialogue "Childhood Immunizations"
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Vaccine Education Center
The Children's Hospital of Philadelphia (CHOP) website provides vaccine-related information for patients, parents, and health care professionals.
Vaccines and Autism
A publication from the Immunization Action Coalition summarizes scientific evidence that refutes any relationship between vaccines and autism. Familiarity with this information may assist providers in parental discussions about vaccine safety.
Vaccine Studies: Examine the Evidence
The American Academy of Pediatrics has compiled a summary of studies regarding vaccines and autism for parents and providers to examine the evidence in order to make informed decisions about this topic.
Responding to Vaccine-Hesitant Parents
The Immunization Action Coalition has developed a handout that summarizes science-based materials that may be useful for providers to address concerns of vaccine-hesitant parents.
Reliable Sources of Immunization Information
Print the following handout of reliable sources of immunization information from the Immunization Action Coalition to share with parents.
Answers to Parents' Concerns about Vaccines
This handout provides answers to parents' concerns about vaccines from Dr. Ari Brown, coauthor of Baby 411: Clear Answers and Smart Advice for your Baby's First Year.
Resources for Vaccine Conversations with Parents
The CDC has assembled a group of provider resources for vaccine conversations with parents.
Personal Belief Exemptions
Information that can be shared with parents who request personal belief exemptions from vaccination is available from the Immunization Action Coalition. The evidence presented will help parents better understand the impact of vaccine refusal.
Documenting Parental Refusal to Vaccinate
The American Academy of Pediatrics has developed a form to be used (or adapted) for providers to formally document a parent's refusal to accept vaccination for a minor child.