The standards for pediatric immunization practice
Does your child's healthcare provider meet the standards?
In May 1992, the U.S. Public Health Service and a diverse group of medical and public health professionals set standards for pediatric immunization practices in response to the recent measles resurgence. These standards, established by the U.S. Public Health Service approved and endorsed by the American Academy of Pediatrics represent the most desirable practices for all healthcare providers and immunization programs.
While the standards are aimed at healthcare professionals, they provide guidance to the public about what to expect from the providers and programs responsible for their child's immunization care. And while the language published in 1992 applies to childhood vaccinations, much of it applies to adult vaccinations as well.
The following is the full text with an explanation of each standard as adopted from the National Vaccine Advisory Committee (NVAC) discussions of the standards.(1)
Ideally, vaccinations should be carried out as part of a comprehensive child health care program. This is the ultimate goal the nation must strive for if all American children are to benefit from the best primary disease prevention our health care system has to offer.
A general improvement of our primary care system requires intensive efforts and will take time. However, we should not wait for changes in this system before offering more effective vaccines to our children. Current public health policies and practices across the board mean that many of our vulnerable preschool children are not getting their vaccines on time. This failure is primarily due to obstacles hampering vaccine delivery and missed opportunities in clinic visits.
Changes in policies and practices can improve coverage immediately. The current system should be geared towards "user-friendly", family-centred, culture-sensitive and comprehensive primary health care that is accessible to users, i. H. children and their parents, fast, efficient and consumer-oriented services. The failure to do so is evidenced by the recent resurgence in measles and measles-related infant mortality, which may portend other vaccine-preventable disease outbreaks.
Current child immunization practices must change if we are to protect the nation's children and vaccinate 90% of two-year-olds by the year 2000.
The following standards of pediatric immunization practice address these issues. These standards are recommended for use byatHealthcare professionals in the public and private sectors who administer immunizations or manage infant and child immunization services. These standards represent the most desirable immunization practices that healthcare providers should strive to achieve as much as possible. By adopting these standards, vendors can begin to improve and change their own policies and practices.
Although not all providers will have the resources to implement the standards immediately, providers and programs that lack the resources to fully implement the standards should consider them a useful tool to better define immunization needs and to mobilize additional resources in the future to achieve the vaccination target “Healthy people 2000”.
Standard 1: Vaccination services are readily available.
By readily available, NVAC meant the times immunization services are provided should fit the schedules of today's working parents as well as the needs of parents who are at home full or part time.
NVAC suggested non-traditional times such as weekends, evenings, early mornings, and midday as possibilities. NVAC also proposed integrating immunization services into days and hours when other child health services are provided, such as B. the special nutritional supplement program for women, infants and children (WIC).
NVAC also recommended providers maintain an adequate supply of vaccines to avoid missed vaccinations or the need for return visits.
Standard 2: There are no barriers or unnecessary requirements for obtaining vaccines.
NVAC viewed “by appointment only” schemes as barriers to vaccination in both public and private settings, and proposed walk-in services with wait times of no more than 30 minutes.
NVAC suggested that such services should be provided in conjunction with rapid and efficient screening (e.g. to assess the child's current health and immunization status) and should not be dependent on receipt of other comprehensive health services. NVAC noted that a physical exam is not required at the time of a vaccination unless a child has symptoms of illness or the visit is a combined visit. It is sufficient for the provider to monitor the child's general health, ask the parent or guardian if the child is well, and ask the parent or guardian about possible contraindications (reasons why the child should not be vaccinated).
Because every child requires consistent health care, parents bringing their child to a "walk-in" immunization service should be advised of the need for a personal GP and referred to such a provider. In public clinics, vaccinations should be carried out according to a plan (standing order) and not according to individual written orders or referrals. This approach avoids the possibility of records being misplaced or vaccination anniversaries being missed.
Standard 3: Vaccination services are available free of charge or for a small fee.
No child should miss vaccinations because parents cannot afford the fee.
For this reason, public clinics with federal contracts to provide immunizations are required to post a sign advising that no one will be denied immunizations because of inability to pay. NVAC recommended that fees should be reasonable in both the public and private sectors.
Standard 4: Providers use all clinical encounters to screen children and immunize if necessary.
Any health care worker who sees your child should be aware of your child's immunization status, even in an emergency room or a specialist's office.
If immunizations are not up to date, vaccination should be provided to your child during this visit or you should be referred back to the primary immunization service provider.
Standard 5: Providers provide general immunization information to parents and guardians.
NVAC expressed concerns not only about the need for information, but also that information should be presented in a language you can understand, and another language if necessary.
The provider should discuss with you the reasons why vaccinations are important, the diseases they prevent, the recommended vaccination schedules, and why it is important that vaccinations are given at the right age. Also, your doctor should instruct you to bring your child's vaccination card to each visit, a step that will prevent both missed and unnecessary vaccinations.
You should have an opportunity to discuss questions and raise concerns, and your provider should have materials to take home to refresh your understanding of what was said.
Standard 6: Providers interview parents or guardians about contraindications and provide specific information prior to vaccinating a child about the risks and benefits of the vaccines their child is about to receive.
According to the NVAC, you should be asked questions to determine (1) whether your child has ever had an adverse event related to a vaccination and (2) whether your child has any medical conditions or circumstances that indicate the vaccination should be withheld or should be postponed (e.g. "Has your child had a fever in the last few days?").
You have the right to be informed about both the benefits and the risks of vaccines. For this reason, the US federal government requires both public and private healthcare providers to provide you with printed materials, called Vaccine Information Statements, related to measles, mumps, rubella, diphtheria, tetanus, pertussis (whooping cough) and Giving out polio vaccines Your child will have one of these. In addition, your healthcare provider should review these statements with you.
Another type of printed material, called Important Information Notices, is required in public health clinics and recommended in private settings to inform you about other vaccinations such as hepatitis B or Haemophilus influenzae type B. All these materials should be current and available in the appropriate languages. Your provider should also ask you if you have read the materials and if you have any questions about the information given to you.
Standard 7: Providers only follow true contraindications.
Your doctor should exercise sound, good judgment about what constitutes a medically valid reason for refusing vaccination, using guidance from the Advisory Committee on Immunization Practices, the Committee on Infectious Diseases of the American Academy of Pediatrics, and the American Academy of Family published guidelines apply physicians.
Standard 8: Providers simultaneously administer all vaccine doses to which a child is entitled at the time of each visit.
The available evidence suggests that co-administration of childhood vaccines is safe and effective.
Measles, mumps and rubella vaccine should always be used in combination when vaccinating children. Concurrent administration or combined vaccines reduce the number of visits or vaccinations required and help ensure your child gets all the vaccinations they need.
Standard 9: Vendors use accurate and complete record keeping procedures.
This standard sets out the proper approach that should be taken to ensure accurate record keeping so that required vaccinations are not missed and unnecessary vaccinations are not administered.
Vaccination providers are required by law to record which vaccine was administered, the date of vaccination (month, day, year), the name of the manufacturer of the vaccine, the batch number, the signature and title of the person who administered the vaccine and the Address where the vaccine was administered. NVAC believes that parents or guardians should also be given a permanent record that they can keep and take with them on office visits for updates. If this record is lost, a replacement with full vaccination records should be provided.
Providers should verify vaccination history from previous providers whenever possible, and if the provider of any vaccination is not the GP, a report of the vaccines administered should be sent to the GP.
Standard 10: Providers schedule immunization appointments along with appointments for other child health services.
This standard recommends efficient use of parent's and child's time and the ability to administer immunizations that might otherwise be missed.
Standard 11: Providers promptly, accurately and completely report adverse events after vaccination.
As a parent, you should be encouraged to report any adverse event that is, or appears to be, related to vaccination.
In turn, your healthcare provider should fully record the event in the medical record and promptly report those events that are clinically significant to the national vaccine adverse event reporting system (VAERS), regardless of whether the event is believed to be vaccine-related. The toll-free number for VAERS is 1-800-822-7967.(2)
Standard 12: Providers operate a tracking system.
Your healthcare provider is responsible for maintaining accurate and up-to-date records of your child's vaccinations and for notifying you when vaccinations are due.
Computer systems make this easier, but providers who have not converted their records to computer storage should maintain a manual system. Children who are at high risk of not completing their vaccination course should be given special consideration in the follow-up system.
Standard 13: Providers adhere to appropriate vaccine management procedures.
In order to remain effective, vaccines must be handled and stored according to the manufacturer's package insert.
A good sign in any doctor's office is that a qualified person is assigned the responsibility of monitoring vaccine supplies: how many are there, where are they stored, how are they handled (e.g. put them back in the fridge right away ?), and the expiry date printed on the bottles.
Standard 14: Providers conduct biannual audits to assess the level of immunization coverage and review immunization records in the patient populations they serve.
Audits are an essential and routine action in any type of healthcare delivery.
Hospitals check how many beds are occupied in a given period, the type and number of surgeries performed, how many patients died in the hospital and why, the types of medications prescribed, and the fees for services. Clinics conduct similar audits.
Individual practitioners may be less inclined to undertake in-depth audits, but a random sample of records can reveal the percentage of children who are up to date by their second birthday, identify missed opportunities for concomitant vaccination, and the quality of the records retained become. These are important steps in ensuring quality care for your child. How do you know if your vendor conducts such audits? Ask the office nurse.
Standard 15: Providers maintain up-to-date, easily retrievable medical records at all sites where vaccines are administered.
A medical protocol is a detailed description of how a procedure is performed. Today's medical technology is changing at an unprecedented rate, so healthcare providers cannot rely solely on memory or past experience when using medical devices or medications. They need to have technical information readily available, either in a computer database or in printed "handbook" form that can be used by both experienced and new employees.
When you see your doctor, nurse, or pharmacist searching for a dosage, drug name, or other information, interpret it as a sign that that healthcare professional is committed to accuracy, safety, and state-of-the-art care.
Standard 16: Providers employ patient-centric and community-based approaches.
Healthcare workers spend most of their day indoors, working long and intensely focused days. Sometimes they're so attached to their routines that any suggestion to do things differently is seen as an affront.
However, if your provider doesn't ask you if things are going well, don't hesitate to say so. If you're having a hard time getting your child vaccinated during the day, say so. If the wait times are so long that your child is getting fussy and you're about to leave the house, your provider needs to know this.
Under this standard, public sector providers have a special obligation to reach out to the community to ensure their services reach everyone, not just the people who routinely come. They should use a variety of methods to inform the public about vaccinations and post the times and places when they are available.
Standard 17: Vaccines are administered by appropriately trained individuals.
This does not mean that only a doctor or nurse should administer vaccinations. In fact, such a declaration can create barriers to vaccination.
In emergency situations - for example after a natural disaster - the need for typhoid or other vaccinations can suddenly number in the thousands per day and the available medical staff would not be able to meet these needs. In the fall, the demand for flu shots can be very high, overwhelming normal office routines and resulting in long, tedious waits. In low-income areas, demand for free publicly funded vaccinations can be high.
Today, the tendency to meet these needs is to use non-traditional locations, even grocery stores, and to use non-traditional providers to administer vaccinations. In many states, pharmacists can routinely administer vaccinations. Few people would think of their dentist as a provider of vaccinations, but why not? In each of these cases, vaccinations can be safe as long as the people administering the vaccinations are properly trained and all other protocols, such as using sterile methods and keeping accurate records, are retained.
Standard 18: Providers receive ongoing education and training on current vaccination recommendations.
Vaccines, immunization techniques, and vaccination schedules change regularly. For example, the recommended method for administering the polio vaccine was recently changed from an oral polio vaccine to a series of injections with the inactivated form of the vaccine.
The change is important because it establishes a safer method. Your healthcare provider should be aware of these and other changes in vaccination recommendations.
Who to call if you have specific vaccine safety questions
For more information on your vaccine safety questions, call:
CDC/National Immunization Program Resource Center
1.National Vaccination Program. Standards for Pediatric Immunization Practices [Monograph]. 7th pressure. Washington, DC: Department of Health and Human Services, United States Public Health Service, Centers for Disease Control and Prevention, February 1996.
2.Food and drug management. Vaccine Adverse Event Reporting System [brochure]. Washington, DC: FDA, no date.