IMMUNIZATION ACTION PLAN 2008/2009

1. IMMUNIZATION ACTION PLAN 2008/2009 KINDERGARTEN AND SEVENTH GRADE Sandra Smith, RN, BSN

2. 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

3. 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

4. KINDERGARTEN

5. 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

6. 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

7. 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

8. SEVENTH GRADE

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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