Immunzation confusion for Well Child

  1. I am working in a small rural non profit clinic. I love kids but are beginning to dread any Well Child Visit. The Dr. marks off what immunizations we are to give the child. Then we have to figure out what type of insurance the pt has and whether they are to get private or public immunizations. Then we have to find the immunizations in the fridge or freezer (which is the part I am having trouble with). Supposedly they are separated according to whether they are public or private and adult or pediatric.....but it just doesn't make sense to me. Nobody has explained what is what to me. And my last two well child visits I had to give 7 separate immunizations that took me forever to pull (and one the dr. marked wrong - which I caught) but that really through my time off and the parent almost walked out because I was taking too long. Any ideas? I know I will learn what is what but still I hate taking forever and am worried I'll make a mistake! Thanks.
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    About elprup

    Joined: Jul '06; Posts: 1,065; Likes: 1,123
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  3. by   saltwaterstat
    maybe geta small pocketsize notebook.
    2 separate sections---- private/public------and the appropriate forms for each.
    and in each...2 more sections frig/freezer....
    and then I would do the age groups...pedies or adult. most definitely speak w/ your nurse manager re your concerns. maybe she can make sure you all have the proper organization in your office re these vaccines. ---and perhaps she could make herself available to you for a double check until you are absolutely sure of yourself. --I know that would take more time, but its just an idea.
  4. by   elprup
    Saltwaterstat:Thanks for the advice. I will do that. One major problem I have is that we do not have a nurse manager, nor do we have a medical director at this time (Drives me nuts that I have no higher ups besides the busy busy Dr. But alas, I just ask my Dr. who also tells me that immuns are confusing to them as well.) Another wierd problem is we run out of immuns and have to use one for the other - or this one is both used as public and private but is only labled as private....and on and on.....which is obviously bad organization skills.

    I will make a better list and go from there...and keep voicing my concerns to clinic director and document those concerns. No way to go but up!
  5. by   BKCinNOLA
    Hi Elprup,
    I work in a peds office and am in charge of all vaccines, so I hope these tips help:
    1. Always leave vaccines in their original box in the fridge. All vaccines that are peds formulated will be clearly marked as so. And the large font on the box just make things easy to find.
    2. Label all purchased vaccines in your fridge/freezer with an easily distinguishable mark: I use bright yellow circle stickers and put a big $ in the center.
    3. If you are confused as to which patients are allowed which type of purchased/private vaccines, contact your state immunization program. They will have literature (usually in a clear concise chart of who can get public vs. private vaccines) that you can post right on the front of the fridge for easy reference.
    4. Your private vaccine vendors are also extremely knowledgeable about all things to do with vaccines. I've found my Sanofi Pasteur Rep to be the most helpful person ever! She even came and organized our fridge/freezer with labeled containers for each vaccine - and put them all in age appropriate order!

    And don't ever let anyone push you to go faster! Take your time and make sure you're doing your job correctly. Your patient and your license depend on it.

    Hope this helps!
  6. by   ElvishDNP
    We used to keep the vaccines (in their boxes of course) in drawer organizer bins in the fridge/freezer, with the name of the vaccine written on the end part of the bin so we knew what was where. You might be able to keep public/private vaxes in separate sides of the fridge to keep them separate too.

    One other thing you might do, just to make your life easier, is know the CDC's pink book forward and back. The office likely has a copy, but if not, the health department surely does and might let you make photocopies for your personal use. If all else fails, you can find it used on (at least you can right now).

    There is a bunch of good information about vaccine spacing, what vaccines to give when, and contraindications for vaccines, as well as accelerated schedules for those kids that need to be caught up fast for whatever reason. Knowing those things might help you anticipate, 'ok, this kid is coming for a 6-month WCC, he'll probably be getting XYZ vaxes' and you can plan your time accordingly.

    That book was my savior when I worked at a community health center. I got index cards, read every chapter, and wrote the highlights on the cards about each vaccine.

    You'll also get faster with time....but the previous posters are also right. You shouldn't be rushed. It's worth doing right. Hope this helps.
  7. by   elprup
    Thanks so much Elvish and BKC. I even ordered my own Pink Book - I think that will be a huge help. Something to teach me the ins and outs...exactly what I need. Wierd that my work place does not have one?!
  8. by   ElvishDNP
    I do find it odd that a clinic that does a lot of vaccines, especially in a rural or underserved area, doesn't have one. Guard that thing with your life and write your name all over it! I'm glad you ordered one, it will be a great resource for you and hopefully for your coworkers as well.
  9. by   kcksk
    ohhh reading this post I realized a couple of things. I am in MA and up to 18 almost all vaccines are state supplied. It's only 19 and over and HPV that we have to determine purchased vs state and that is a pain.

    That being said, once you get used to doing it, you will get used to how your clinic does things. Practice is really the only way to get used to things. I remember being totally overwhelmed when I started and very quickly I was a lot more comfortable. If they don't already, make out a sheet that stays the vaccines anticipated at each well visit. For example ours might look like this:

    1 mos Hep B #2
    2 mos Pentacel (Dtap-Hib-IPV), PCV 13, RotaTeq
    4 mos
    6 mos
    12mos MMR #1, Varivax #1
    18mos Hep A #1
    4yrs Dtap #5, IPV #4, MMR #2, Varivax #2

    obviously I didn't fill them all in but you get the idea.

    then the flu is added to visits 6mos plus during flu season.
    It made it easier when the MD said give 4 yr shots....then you just had to look to make sure that was what was really due. i notice when kids come from other states/countries that the schedule isn't the same so a lot of kids play catch up. You can pull of the immunization recommendations on There is also a chart that tells you what is the earliest someone can get a vaccine, the max age for them to get it (for example RotaTeq can't be given over 8 mos old, and minimal intervals between doses.
  10. by   elprup
    Thank you. You Rock. Love your ideas. Funny how being overwhelmed turns off my brain to easy solutions.