Community Guide UseThe Duval County Health Department used vaccination findings and recommendations from
The Guide to Community Preventive Services (The Community Guide) to increase 4:3:1:3:3:1 series immunization rates among their two-year-old population by 15% in two years. Click the PDF icon to download the full text of this Community Guide success story.
Implementation
The Duval County Health Department recognized that there was a problem with children being vaccinated as recommended by the Advisory Committee on Immunization Practices' (ACIP) standards. Duval County immunization rates have been ranked among the lowest in Florida. The health department wanted to identify evidence-based strategies to improve the consistently low immunization levels of the two-year-old patient population in its clinics by increasing the rate of the 4:3:1:3:3:1 series from 75% to 90% by June 30, 2011. In 2009, they initiated a quality improvement project to address the issue. The QI team used the Plan-Do-Study-Act (PDSA) model to systematically research, identify, modify, and implement solutions. During the planning and discovery stage, the following challenges were identified: most clinics were not utilizing the Florida Shots immunization registry to identify children who should be provided reminders when they are due for immunizations, staff who had opportunities to administer vaccines were not trained or authorized to do so, some physicians preferred to delay some vaccines, educational materials were confusing to parents, and missed opportunities were not being identified properly. The Community Guide provided several evidence-based strategies for the health department to consider in addressing these barriers. In 2010, Duval County Health Department implemented an Immunization Service Line, which incorporated the following Community Guide recommendations:
- Patient reminders and recalls: Incorporated the use of the Florida Shots registry to extract data indicating which children needed reminders and recalls on a monthly basis. Many errors in data were discovered through this process, such as children that were no longer in the area or who were no longer clients.
- Health care system-based interventions (education and policy): The health department had staff to administer vaccines, but they were not trained or authorized to do so. Also, physicians were accessible but decided not to give the necessary immunizations, creating missed opportunities. The health department implemented a large-scale training for all clinics, which trained Health Technicians and Licensed Practical Nurses to administer the vaccines, which were formerly only administered by Registered Nurses. In addition, policies that clearly reference ACIP recommendations for vaccination were communicated to providers and combination vaccines were made readily available.
- Community-based interventions (educational media for parents and caregivers): Originally, printed educational materials on immunization showed the range of time a child could receive vaccines and still be considered up-to-date, instead of including a timeline indicating when a child should receive shots. Following clarification of policy for children to obtain immunizations at the earliest eligible opportunities, educational posters were revised and distributed to reflect recommendations that would maximize immunization rates.
Outcomes
By March 2011, 90% of the two-year-old patient population was up-to-date on the 4:3:1:3:3:1 series, compared to 75% in 2009 (15% increase).
Model Capacity
Duval County Health Department is currently documenting and sharing best practices with private community providers. Community providers and partners will also be provided the link to The Community Guide website.
Resulting Changes in Practice
- Patient reminders and recalls
- Health Technicians and Licensed Practical Nurses are authorized to administer vaccines
- Immunization policies are based on ACIP recommendations
- Combination vaccines are readily available
- Educational posters for parents now reflect immunization best practices