Training non-nurses for shot records

[Purple_Scrubs]

Do any of you train your office staff to review shot records and determine compliance? We are supposed to start doing this so that the office staff can review shot records when the nurse is absent. I understand the thought behind this, but it took me over a year to get really comfortable reviewing shot records, and that was when I am looking at them every day. Is it really fair to expect an unlicensed person to be able to determine compliance when given a brief training and they do not look at it again for maybe months?

Just wondering how this is handled elsewhere. Do any of you train others to look at shot records? Who does this in your absence?

[Purple_Scrubs, BSN, RN]

Thanks everyone for the input! I think this new "mandate" came about due to some problems at other schools. After talking it over with my principal and the attendance clerk who does enrollments, it has been working just fine for us the way we have been doing things. Regardless, I still gave the clerk some training on shot records, but she knows to tell the parents that the school nurse has to look over them more closely and give the final ok. I am rarely absent, so it should rarely come up anyway. Thanks again for the great thoughts!

[Spidey's mom, ADN, BSN, RN]

I'm brand new (last November) at this job.

I have an awesome health clerk who does this. She even investigated who needed the new mandated Tdap and made a bright red space on that part of the school record that is online.

The secretary at one elementary school is also awesome at this.

The rest (another elementary school, two high schools, and special ed and community day schools) are not.

I do not have the time to be the one doing this. So, I thank my lucky stars this job came with such a great health clerk.

Here is the California mandate info:

http://www.shotsforschool.org/

We are working on getting this done before summer - kids in the 6th grade, going into 7th and then 7th - 12th graders MUST have this shot before school starts or they cannot walk onto campus.

It's been tough - but we are getting there.

[Heidi the nurse, BSN, RN]

this pertains more to exemptions than to who does the shot records, but i thought it was interesting. from our county's health department regarding the just passed legislation to have parents talk with their hcp about immunization exemptions:

a pilot project in a pierce county school district in 2010 showed that many exemptions are provided from convenience rather than conviction. when vaccine records were reviewed it was found that about a third of the exemptions were being claimed for vaccinations children already had. follow-up with calls to parents claiming exemptions found that many were willing to have their children come in for immunizations and few were adamantly opposed to vaccinating their children.

i have found it interesting when reviewing shot records for exemptions that often times there will have had immunizations until the age of 2 or 3, then the exemption for that one shot needed after the 4th birthday. maybe the convenience part of it explains that.

[Jolie, BSN]

So in your states, what type of documentation is required for exemptions?

In NE, medical exemptions must be signed by a physician or advanced practice nurse. No one else will do, much to the dismay of families who try to pass off a note from their dentist or chiropractor.

Religious exemptions are signed by parents, but require notarization, which cuts down on frivilous or lazy reasons.

[Heidi the nurse, BSN, RN]

Starting in July, WA will be like NE, although I think our list of HCP is a bit broader (PA's would be ok). Now, all the parent needs to do is sign the form - no need to talk to anyone. And a couple years ago, the exemption form was on the back of the CIS form, so all they had to do was turn it over - at least now they need to ask specifically for it. I think one of the main problems was people wouldn't have their shot record and would just see the exemption form on the back and sign it because they wanted to get their kid enrolled. I have to admit when I enrolled my last child in Kindergarten a couple years ago I was tempted to do that very thing because although I knew she was up to date, I didn't have the last round of shots on her record and they wouldn't let me enroll her without them. I am a busy person but thought that would be a bad example :) although it kind of irritated me that they wouldn't let me get the dates and get back to them. I can see how parents would do it out of convenience.

[Spidey's mom, ADN, BSN, RN]

So in your states, what type of documentation is required for exemptions?

In NE, medical exemptions must be signed by a physician or advanced practice nurse. No one else will do, much to the dismay of families who try to pass off a note from their dentist or chiropractor.

Religious exemptions are signed by parents, but require notarization, which cuts down on frivilous or lazy reasons.

Now in CA - medical exemptions must be signed by the physician or advanced practice nurse.

But religious exemptions - that's still just the parents sig. I like that notarizing idea.

We added a part that says if a child in the school comes down with whooping cough - the un-immunized child would have to be out of school for about 2 weeks. That cut down on exemptions.

[schooldistrictnurse]

In WI, a physician's signature is required for medical exemption, but religious and personal conviction are just a parent signature. We had a pertussis outbreak earlier this school year and it was up to the local health dept if those not immunized or under-immunized would be excluded from school. The decision was not to exclude, but I did have to contact all those parents to make them aware of the outbreak and give signs to watch for, etc, etc.

Someone asked earlier if secretaries entered health room visits and yes, they do. Health room visits are handled by secretaries or volunteers, and secretaries enter the visit in PowerSchool, our computerized program. I'm curious about how many states have an internet registry for immunizations. It really helps when parents give a month and year for immunizations (not acceptable) and for parents who don't keep any records (really?) at all.

Seems like more of this should be standardized across the country.

[Spidey's mom, ADN, BSN, RN]

Our public health department started a registry a few years ago. We have access to it at the school district.

Because of the new mandate to immunize all kids in public school that will be in 7 - 12 grades in the fall, we must exclude students who don't get the shot when we have an outbreak.

Public Health is coming onto campus and doing shot clinics - something they were reluctant to do initially. But they've done a great job getting all the paperwork ready.

[Heidi the nurse, BSN, RN]

We in Washington State have a state wide registry too - I believe they are working on getting it to "talk" to other registries in the country. Or at least get it to talk to the registries it doesn't already talk to.

[Spidey's mom, ADN, BSN, RN]

We in Washington State have a state wide registry too - I believe they are working on getting it to "talk" to other registries in the country. Or at least get it to talk to the registries it doesn't already talk to.

We were just given a log-in and password of our own.

[AdobeRN]

Texas has a chart that really is not that difficult to figure out. Our data clerk is great & pretty much can look at a record now and tell if it is up to date. It really helps me out especially when Kinder registration rolls around.