Vaccination Hotshots
Who says raising immunization
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To learn more about the Clinic Assessment Software Application program, call (916) 447-7063, ext. 334.

Related Sites

Centers for Disease Control and Prevention (Clinic Assessment Software Application program)

California Department of Health Services immunization branch

    
     
     

By Mary Ann Hellinghausen
Photo: Young Kim
September 20, 1999

Madalyn Wyatt, RN, and Nancy Gilfillan, RN, bring a unique twist to their goal of raising immunization rates in private physician offices in the Sacramento, Calif., area—they try to make it fun.

By bringing in lunch for the entire office staff, providing continuing education credits and goody bags, and sending poetic reminders throughout the year about the importance of immunizations, Wyatt and Gilfillan are hoping the physicians and their staffs will be more diligent about immunizing children under the age of 2 and keeping good immunization records.

Wyatt and Gilfillan are part of the Shots for Tots Regional Coalition in the Sacramento area, which is striving to reach a 90 percent immunization rate for toddlers in the seven-county North Central Valley region by 2003. According to a state survey, the region’s current rate is 57.8 percent, compared with 62.9 percent statewide.

“We’re trying to bring the issue of immunization to the forefront and let the whole staff know they can make a difference,” Gilfillan said. “Our real satisfaction will come later this year, hopefully, when we see if our feedback made a difference.” The three-year program is being funded by a $110,000 state grant.

Private physicians targeted

During the first year of the project, which is voluntary on the part of physicians, Wyatt and Gilfillan assessed immunization records in the offices of 60 private physicians in El Dorado, Nevada, Placer, Sacramento, and Yolo counties. Using a Clinic Assessment Software Application (CASA) developed by the national Centers for Disease Control and Prevention, the nurses determine the percentage of 2-year-olds who are up to date on their immunizations.

While each office’s scores remain confidential, the combined immunization rate for the 60 physician offices from the CASA assessment was only 48 percent, Wyatt said.
     
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During a follow-up lunch for the office staff, courtesy of pharmaceutical companies, Wyatt and Gilfillan inform the staff of their percentage rates and educate them about what they may be doing wrong if their scores are low. “Our project has been unique because these feedback sessions include the whole office,’’ Gilfillan said.

“We try to do it a nice, upbeat manner,” Wyatt added.
Madalyn Wyatt, RN, left, and Nancy Gilfillan, RN, work to increase immunization rates for kids. (Photo Courtesy of Madalyn Wyatt)  
 

The biggest problems, they found, were sloppy record-keeping and untrained medical assistants who sometimes did not know how to give shots, were unaware of proper immunization schedules, and did not know how to properly store vaccines. Private physicians are hiring more medical assistants for their office staff because they are less costly than RNs or LVNs, the nurses said.

“We try to stress working as a team, to get your staff at the front desk to ask mom for their child’s immunization record,” Wyatt said. “Working as a team will not just change immunization rates, it will spill over into other areas.”

Outbreaks still occur

Many healthcare workers have become complacent about immunizations, believing such diseases no longer pose fatal threats, officials say. But the state has recorded 50 deaths among California children ages 4 and younger from 1988 to 1991 due to a measles epidemic. And since 1988, 21 children ages 4 and younger have died of pertussis (whooping cough) in the state. Meningitis and pertussis tend to have more fatal consequences among children 2 and younger, Wyatt said, highlighting the importance of vaccinations by age 2.

Beginning in October, Wyatt and Gilfillan will revisit the 60 physician offices to reassess their rates, and they are confident they will see an improvement. “Their approach is very energetic and positive, and we expect to see good results,” said Norene DeBruycker, director of the Shots for Tots program.

“We’ll be shocked if there’s no change,” Wyatt said. Meanwhile, the two will add initial assessments in another 45 offices this year and may extend into Sutter and Yuba counties.

When the grant expires in 2000, officials hope to get another grant to provide immunization training for medical assistants, DeBruycker said. “We feel a comprehensive approach is better than a one-stab approach.”