Primary Care and Immunization Compliance

Specialties School

Published

I used to work at a pediatric primary care clinic in Washington DC. We had the immunization requirements for entering school posted in our waiting rooms, the residents who worked at the clinic all had copies of the requirements for kids entering Kindergarten, the front desk knew to schedule all four year check-ups on or after the fourth birthday, and I can say that 99.9% of our kids who came in for their four year check-ups received the required immunizations they would need to begin Kindergarten. Once in a blue moon, we would have a parent call saying the school was excluding them because they were not UTD and we could always figure out what had happened (kid no-showed and never rescheduled, or was febrile the day they should have been vaccinated, etc.). Sometimes the school made a mistake and got dates wrong, etc.

Now I live in MA and am a school nurse here and I am shocked at how many of our kids do NOT have immunizations that are required for Kindergarten. My own kids go to a practice that does not routinely immunize at the four year visit, so all those kids who have an UTD physical to enter K, might not have UTD immunizations because they turn five after the visit but before they start K. And as I look through student's immunization forms, it looks like it is a free for all at the pediatrician's offices and they all practice differently. I just submitted the annual Kindergarten Immunization Survey for my state and I have 10 kids out of compliance. Of those 10, 9 all had physical exams sometime in the last 4-6 months and their primary care providers, for whatever reason did not immunize them with DTaP, IPV, MMR and Varicella. I find it hard to believe the parents did not mention they would be starting school in the Fall. I don't get it. So now they are trying to get appointments to go back in, the clinics say "you are UTD and your insurance won't cover another visit until a year from now" :banghead: Not sure what to do here and they of course get frustrated with ME because I am telling them they are out of compliance and the peds are telling them they are UTD.

I miss my super organized clinic in DC that was ON IT with immunizations!

What are you seeing in your area and have any of you worked with the local pediatricians offices to streamline this process a little better.

Many if not all of my students have Mass Health (Medicaid).

Thanks.

Specializes in Pediatrics Retired.
How does the DOH react to this? Don't they get fined?

I'm not sure how they get away with it other than they have a standard parent declination form, since it's an "opt in" for parents to have the immunizations reported. Or they're just stupid.

Our pedi offices are really good at administering the required vaccinations. But they don't send out reminders. If you're proactive and maintain the regular scheduling of your child's well visits, your kiddo will always be UTD on their vaccines. But they're certainly not going to hunt you down. We also have a few that don't use the state registry or don't use it consistently. My 1 year old daughter has more vaccines entered into our state registry than my 9 year old son does and they've both been registered since their first visit to our pedi. They just don't always take the time to enter them in I suppose.

Specializes in IMC, school nursing.

Very timely, as I have been out of my office these last two months and vaccination survey is two and a half weeks away and I am sending out lots of exclusions. I feel horrible that I did not send out individual emails, but I have sent out 6 generic requests.

Specializes in School Nursing.

My school has PK, but they are not required to have their 4yo shots until Kinder. I keep this on the down-low and send notices home throughout PK so those shots are UTB before kinder. Unless the parent looks at the state law, they don't know PK4 has that window. I just tell them, "hey, so and so needs his/her 4 yo shots".. it helps with Kinder compliance!

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