SDIB Website: Health Care Professionals: Ways to Improve Your Practices

You can make a difference!

Use every office visit as an opportunity to immunize!
Check immunization status at every encounter including well and sick visits. Use only true contraindications. A mildly sick child can often still be immunized. Reassure parents about the need for and safety of vaccination even when the child is ill. (If you defer vaccination due to a serious illness, let the parent know when to return for the missing doses).

Give all immunizations that are due. Simultaneous injections are preferred and safe.

To be up-to-date, by 18 months of age a child must have 4 DTaP, 3 Polio, 3 Hep B, 3/4 Hib (must include one dose on or after the first birthday), 4 PCV (must include 1 dose on or after the first birthday), 1 MMR, and 1 Varicella. Statistics show that the vaccine most often missed is DTaP #4.

Additionally, California is designated by the CDC as a high-risk area for hepatitis A. All children aged 1-18 years are recommended to complete the 2-dose hepatitis A series; the doses are given 6-12 months apart.
Implement a reminder/recall system
Contact San Diego Regional Immunization Registry about integrating this computerized system into your office practices. If you do not have a computerized prompt such as the registry, have the parent address a postcard and place it in a tickler file organized by months. This simple system will get patients back to your office.
Educate parents
(9 out of 10 parents whose children are behind don't know their child is not up-to-date) Teach parents to bring their child's record to EVERY visit - sick or well. Ensure that staff review the record at each visit and give feedback to the parent.

Provide educational materials, which must include the Vaccine Information Statements (VISs) which are required by law.

Address common misconceptions. Take a moment to answer parents' questions about vaccine safety and discuss the importance of returning to the office to get the child's shots on time.

Stay up-to-date with changes in immunization recommendations and school/child care requirements.

Tell the parents when their child's next immunization is due.
Maintain a list of resources
... including this website, to refer parents for more information.
Work as a team
Encourage all staff to actively engage in ensuring that all children are up-to-date on their immunizations. Who makes the appointment? That person should remind parents to bring the shot record to each visit and should remember to always schedule the 12-month visit after the first birthday to provide MMR and Varicella vaccines and boosters for Hib, DTaP and pneumococcal vaccines. Who prepares the chart? They should flag the immunization record for assessment, or assess the immunizations for the provider and note the needed vaccines. Provider? Assess immunization status at each visit and order all needed vaccines.
Improve documentation
Identify one central immunization summary form to record all immunizations given, including those given elsewhere. Providers are encouraged to use the Immunization Record and History Form, provided at no charge by the California DHS. It can be obtained by calling the San Diego County Immunization Branch at (866) 358-2966.
Know your immunization coverage rates
If you practice in San Diego County, contact the Immunization Management Consultancy to arrange for annual assessment of your coverage rate and develop strategies to improving immunization practice management. This service includes a chart assessment of children 19 - 35.9 months of age as well as an educational inservice to discuss practice-specific strategies.

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