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IMMUNIZATION ACTION PLAN 2008/2009. KINDERGARTEN AND SEVENTH GRADE Sandra Smith, RN, BSN. OBJECTIVES. Early identification of non-compliant children Increase the Kindergarten/Seventh Grade immunization rates to at least 90%

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immunization action plan 2008 2009

IMMUNIZATION ACTION PLAN 2008/2009

KINDERGARTEN AND SEVENTH GRADE

Sandra Smith, RN, BSN

objectives
OBJECTIVES
  • Early identification of non-compliant children
  • Increase the Kindergarten/Seventh Grade immunization rates to at least 90%
  • Address the nursing shortage at the Miami-Dade County Health Department Special Immunization Program clinics
  • Decompress the summer rush at the SIP clinics/health fairs and the medical providers’ offices
  • Ensure that children attending Miami-Dade County Public Schools are appropriately protected against vaccine preventable diseases
  • Increase the amount of children immunized against Tetanus-Diphtheria-Pertussis (Tdap) via a booster dose
participants
PARTICIPANTS
  • Miami-Dade County Health Department (MDCHD)
  • Miami-Dade County Public Schools (MDCPS)
  • The Children’s Trust (TCT)/Health Connect in Our Schools (HCiOS)
  • Federally Qualified Health Centers (FQHC)
  • Health Management Organizations (HMO)
  • Hospital Organizations (HO)
  • Private Medical Providers (PMP)
  • Bureau of Immunization (BOI)
  • Vaccines for Children Program (VFC)
  • National Center for Infectious and Respiratory Diseases (NCIRD)
  • Miami-Dade County Residents and Visitors
kindergarten requirements
KINDERGARTEN REQUIREMENTS
  • Booster dose: DTaP/DTP/DT, IPV, MMR
  • Two doses: Varicella Zoster Vaccine (VZV)
  • Must be 4 – 6 years old
  • Must be entering Kindergarten
  • Must be current MDCPS student
  • Must have either a MDCHD SHP or HCiOS health team assigned to the school
active reminder process
ACTIVE REMINDER PROCESS
  • Partnerships must be established to support the initiative
  • All VFC Program medical providers must use FLSHOTS
  • All immunization records input into FLSHOTS must be accurate (“junk in – junk out”)
  • All participants of the initiative must follow the Standards for Childhood and Adolescent Immunization Practices
strategies for improvement
STRATEGIES FOR IMPROVEMENT
  • All participants should take advantage of the Co-CASA/AFIX Reviews offered by the BOI
  • All participants should remain current with annual/biannual immunization updates
  • An annual immunization forum needs to be organized to update participants on changes to the immunization schedule
  • Partnership should be established with the pharmaceutical companies to educate medical providers on current and upcoming vaccines
  • CME/CEU credits should be offered
  • CDC guest speaker/other accredited lecturer should participate at the forum
  • Establish teams of seasoned RNs to travel throughout Miami-Dade County to visit providers’ offices to update them on site
7 th grade requirements
7th GRADE REQUIREMENTS
  • Tdap vaccine (one dose) – booster dose
  • Must be 11 years old
  • Must be 5 years since last dose of DTaP/DTP/DT
  • Must be current MDCPS student
  • Must have either a MDCHD SHP or HCiOS health team assigned to the school
preliminary process
PRELIMINARY PROCESS
  • Print listing of 6th graders’ immunization expiration dates
  • Include the date the list was printed
  • Sort the list based on the qualifying criteria for Tdap
  • Ensure that the list is accurate (child is/will be due for Tdap vaccine)
  • Concentrate on immunization records one month in advance (January’s records in December)
  • Arrange the records by the month they expire
  • Split the month in two (every 15 days)
active reminder process11
ACTIVE REMINDER PROCESS
  • RN must mail letter notifying parent/guardian that child will be out of compliance within 15 days
  • Use letter to notify parent/guardian of options to bring child in compliance
  • Document date letter sent on printed list
  • MDCPS’ autodialer needs to contact parent/guardian after hours to remind them that the child will be out of compliance within 15 days
  • MDCPS’ database should automatically update contact system of date of first contact
active recall process
ACTIVE RECALL PROCESS
  • RN must check the records after 15 days
  • If children are still out of compliance, then a phone call must be made to the parent/guardian
  • Parent/guardian must be notified that the child is now out of compliance
  • Provide the parent/guardian with options to bring child’s immunization status current
  • Document date of phone call on printed list
  • If child’s immunization status is current, remove child from printed list
  • Document date that immunization status became current
active recall process cont d
ACTIVE RECALL PROCESS (CONT’D)
  • MDCPS should mail a notification letter on school letterhead notifying parent/guardian that child is out of compliance
  • Since letter is generically generated, the database should retain the date the letter was mailed on file
  • RN must check immunization status 15 days later
  • Any child out of compliance must be followed up with a phone call by the health suite staff
  • Parent/guardian must be notified that their child will be remanded to them pending updating of immunization status
  • The date that this phone call is made must be documented on the list
suggested alterations
SUGGESTED ALTERATIONS
  • HCiOS/SHP health teams need to adopt a tickler reminder/recall system to ensure 6th graders’ immunization status current before the summer
  • MDCPS needs to adopt the Immunization Registry FLSHOTS
  • Using FLSHOTS will allow MDCPS to automate a reminder/recall tickler system
  • MDCPS needs to update their database to trigger when immunization status is late by at least one month
  • MDCPS needs to update their database to trigger non-compliancy when 6th grader is 11 years old and 5 years since last dose of DTaP/DTP/DT
  • MDCPS needs to update their database to remind/recall non-compliant child using quarterly Progress Note until immunization status current
strategies for improvement15
STRATEGIES FOR IMPROVEMENT
  • Educate Administrators/teachers/staff/parents/guardians on the immunization initiative
  • Use all means of group contacts to spread the word (Open House, PTA meetings, parent-teacher conferences, concerts and other gatherings)
  • Influence coaches to educate their players on updating their immunization status
  • Use a reward system to encourage the 6th grade class with the most up-to-date students (pizza party, field trip, etc.)
  • Utilize the informational highways of the media (internet, television, print, word-of-mouth) to educate/inform the community about immunizations and the initiative
  • MDCPS and MDCHD/HCiOS must work in tandem to bring 6th graders current
  • A letter of support for the initiative needs to come from Dr. Leguen as the Medical Director of the MDCHD