Overcoming Immunization Challenges in RHCs Becky Shipp, RN MSDH Immunization Program Director

Discussion Topics Addressing Immunization Challenges Time & Competing Priorities Lack of Awareness & Vaccine Hesitancy Complex Processes & Training Cost & Resources Overcoming Immunization Challenges Streamline & Normalize Promotion & Education Assign & Support Review & Plan

Streamline & Normalize Get the entire office involved Medical & non-medical staff should be included Meet with staff to discuss why vaccinating is so important Staff need to understand the dangers of the diseases that they are protecting patients from Empower team members to take an active role in protecting the patients you serve Allow everyone to contribute suggestions and assistance Establish a culture of health in the workplace Encourage staff to ensure that they protect themselves and their families from vaccine preventable diseases

Streamline & Normalize Non-medical Staff Involvement Check-in Process Print the patient’s immunization history from MIIX Highlight the forecast at the bottom & provide a copy to the patient Provide a copy to the medical staff or flag the EHR to denote vaccines forecasted as due Assume all patients will elect to receive vaccines Provide Vaccine Information Statements (VIS) for each forecasted vaccine Utilize vaccine contraindication screening forms Check-out Process Schedule next appointment for immunizations

Patient Vaccination Record

Streamline & Normalize Medical Staff Involvement Review the MIIX or EHR vaccination forecast at every visit Use standing orders to streamline the process Make presumptive announcements regarding vaccinations “The nurse will administer your flu and Tdap vaccinations today” Answer questions or concerns just as you would any other questions or concerns regarding medication Implement refusal forms for parents to sign if they refuse vaccination The refusal form helps to emphasize your dedication to protecting the patient’s health and seriousness of preventable diseases. Share information with patients and parents on where to find trustworthy health information online

Promotion & Education Non-medical Staff Involvement Promote the importance of immunizing Fliers at the front desk and checkout desk Posters in the waiting rooms Use MIIX or EHR reminder recall systems Schedule next appointment for immunizations Consistent messaging to patients Vaccinations are important because they help to save lives and prevent hospitalizations

Promotion & Education Medical Staff Involvement Promote the importance of immunizing Hang posters or fliers in each clinical care room Provide guidance to non-medical staff on specific ages to focus on for MIIX or EHR reminder recall systems 20 months to 3 years 13 years to 18 years Strong provider recommendation Share with patients that you protect yourself and your family through immunizations Consistent messaging to patients Vaccinations are important because they help to save lives and prevent hospitalizations

Assign & Support Assign Select a specific person as the Vaccine Champion for the office Delegate responsibilities to every staff member Stay up-to-date on immunizations and processes Provide training to medical and non-medical staff as needed Oversee and share the team’s progress through Vaccine Coverage Rate Reports (available in MIIX) Contact the MSDH Immunization Program for assistance

Assign & Support Support Medical and non-medical staff members should support one another’s efforts to vaccinate patients Ensure that leadership and administrative figures show support of vaccination efforts Lead by example Allow staff time to participate in immunization training opportunities Encourage participation of all staff members during VFC site visits

Review & Plan Review all potential opportunities to reduce financial barriers Enroll in the Vaccines for Children (VFC) program to receive vaccines to administer to eligible children Seek guidance from vaccine manufacturer representatives for potential: Coding cheat sheets to improve accurate billing Vaccine purchasing discounts Postage paid postcards Reminder recall services Review AAP’s literature on financing, ordering, and maintaining vaccine supply Review IAC’s Vaccinating Adults: A Step-by-Step Guide

Review & Plan Make plans using available resources and evidence based practices CDC.gov Immunization Partners Immunization Education & Training Section CDC-INFO On Demand – Publications 2018 Vaccine Storage & Handling Toolkit VaxView for Vaccination Coverage Rates by State Vaccine Safety Immunize.org Vaccinating Adults: A Step-by-Step Guide Wealth of information on vaccines, diseases, clinic tools, standing orders, templates, handouts, staff materials, VIS translations

Review & Plan AAP.org HPVRoundtable.org UMMC & American Cancer Society Ordering, Financing & Maintaining Supply Provider Resources Parent Resources HPVRoundtable.org Cancer Prevention Through HPV Vaccination: An Action Guide for Small Private Practices UMMC & American Cancer Society HPV Vaccination ECHO Monthly sessions starting in December 2018 E-mail mwilliams16@umc.edu CDC-INFO On Demand - Publications

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