Training non-nurses for shot records

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Specializes in School Nursing.

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?

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Specializes in school nursing, home health,rehab, long-.

Hello Purple Scrubs,

I have not trained anyone with shot records. When families come in the office staff gets that glazed over, deer in the headlights look with a hint of "I don't know nothing about no shot records." Kidding aside, I agree with you. Even for those of us that deal with it everyday it is tricky. To expect them to do it with is asking a bit much. Or at least without mistakes is a bit much. There are so many variables. The 'if thens', as far as how old they are when the injection was administered. The different names of the vaccines. The combined vaccines. We all know from experience that the doctors even miss them. I had a kiddo with a computer generated shot record from the doctor that appeared to have all of his DPT shots. There were 4 four dates but two were the same date. I called and checked and there was no separate fourth date he had only received 3. His records appeared to be complete for a long time when they in fact were not. It can be complicated. If I were having to train them though I would start with each age and what they must have. Then address each little exception. Ex. DPT -5 doses . With one after 4th birthday. However,4 doses if 1 after 4th birthday etc. Then give them the lowdown on the aliases these vaccines can go by and what they all can contain. Proquad, Pediatrix, your combos if you will. I'm not sure what state you are in, but Texas has a nice chart this year for the immunization requirements. Get your states version and see if that would be helpful. My counties health department is very supportive. I'd get their number and give it to my office staff. TDH nurse ROSA was always very patient and helpful. Thank goodness.

If you can let the folks that are requiring you to train the office staff know that they can do the best that they can to try and muddle through but you will have to check when at you earliest convenience to make sure it o.k. until they are confident and you are confident in them. Please do not think that I do not believe that they can't grasp this task. However, when I say muddle it is because sometimes I have to muddle through C.S.I. style with 5 different shot records, from three different clinics, one from a school, and the one in Spanish from Mexico that looks like it has been folded no less than 57 times and been through the washing machine. Dried too.

I know this was long winded, but this is where I would start and see how it goes.

One last thing. Does your regions service center offer any courses on immunization requirements that might be helpful for the office staff. If not them perhaps the heath department. Those ideas might be an option.

Let me know what happens.

Hang in there.

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Specializes in School Nursing, Public Health, Home Care.

Shot records are viewed as a secretarial duty in my district. I oversee the secretaries in this task. The State of Wisconsin puts out an annual booklet with requirements, vaccine names, definition of "behind schedule" and "in process" etc etc etc. The secretaries are very willing to ask for me to double check their entries, especially with foreign records. Our state has an internet database of immunizations, which is clear and easy to read. I spot check entries at each building every year. We have 2600 students in the district and I am half time. There is no way I could do the data entry (is that nursing?) for all students. I would love to do it myself (control issues) but this is just the way it is in my district.

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Specializes in school nursing, home health,rehab, long-.

Hello school district nurse,

I only have around 400 students give or take. I am full time on my campus. Before school starts I come in about 2 weeks early and enter all of my immunization data. However, that is exactly what I feel like for those few weeks. A secretary with a bunch of initials after my name. I am able to get it done. (I have smoke flying out of my keyboard trying to get it done a quickly as possible. Just watch those magic fingers fly:). In a way it is kind of a luxury. I used to do this for 986 students at my last campus. I feel like I am getting a break after those 2 years. If I had the load that you did and part time at that I would have to do things differently as well. I input their daily visits, hearing, vision, and scoliosis information into the computer. Do your secretaries do this as well? Just curious. By the way control issues here as well. Just throwing that out there. Letting you know your not alone:). I think it comes with the 'nursey' territory. Isn't our profession the greatest though. We are all school nurses, yet I bet each of our days are so completely different we would be hard pressed to see the similarities. I wouldn't trade it for anything.

Talk to you soon.

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Specializes in school nursing.

I would just hate to hear the backlash of trying to bring students up to compliance. "But that other 'nurse' said everything was fine."

I just feel that the more we delegate to non-medical staff, the more it looks like our services are not needed!

Obviously, in cases such as posted where you are stretched really thin...you have no choice but to delegate!

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Specializes in School Nurse.

In our district, the registrar is the "first line of defense" for immunizations - then they usually pass it on to the health clerk, who works with them daily and frankly is much better at it than I am. I have to get out the flow sheet because I can't remember all the various shots and time frames and intervals. I am more likely to tell someone things are ok inadvertently than the health clerks.

The only time we have issues is in the summer when the district office does registrations and the people there don't deal with things every day. That is always a nightmare because a second set of eyes doesn't review it, and imputing shot records usually takes a couple weeks with all the other duties our health clerks have at the beginning of the year. So by that time the kid has been in school for a couple weeks, enrolled for months, and we have to call parents and let them know they are out of compliance.

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Specializes in School Nurse.

Oh, and one good tip for purplescrubs - find a cheat sheet for the various immunization names. It will make everyone's job so much easier, especially if you have alot of military or foreign families. Here is one from our CIS form:

http://www.doh.wa.gov/cfh/immunize/documents/certimmunstatus.pdf

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- Registered nurses in schools who interact with parents are correlated with increasing immunization rates (Ferson, MJ, Fitzsimmons, G, Christie, D, & Woollett, H, 1995; Salmon et al., 2005)

- Salmon et al. (2005) found parents were significantly less likely to request an exemption from immunizations than school personnel without health care training. Unlicensed school personnel were unaware of the seriousness of vaccine-preventable diseases, as well as the susceptibility of the unimmunized children (Salmon et al., 2004).

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Specializes in School Nurse.
- Registered nurses in schools who interact with parents are correlated with increasing immunization rates (Ferson, MJ, Fitzsimmons, G, Christie, D, & Woollett, H, 1995; Salmon et al., 2005)

- Salmon et al. (2005) found parents were significantly less likely to request an exemption from immunizations than school personnel without health care training. Unlicensed school personnel were unaware of the seriousness of vaccine-preventable diseases, as well as the susceptibility of the unimmunized children (Salmon et al., 2004).

This might be an interesting research project for someone in my state. Not to long ago, we were dead last in the Union when it came to exemption rates. At some point, we moved up to #47. Several years ago the state seperated the CIS from the exemption form the parent needs to sign. This year, out state finally passed a law that the parents need to have a clergy signature for religous reasons, and talk with their HCP for personal or medical exemptions.

I have always been proactive with counseling vaccine hesitant parents, but I have a feeling this new law will do way more to decrease our exemption rates than talking to all the school nurses in the state.

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There are a lot of right avenues to good outcomes, School nurses are one of them

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Specializes in school nursing, ortho, trauma.

I am fortunate enough to have a part time clerk in my office who now knows how to read an immunization record. The guidance secretary ( who was the main office secretary when I worked at the K only school) also has a rough idea of how many shots need to be on a record, but at the end of the day the buck stops here.

I made up a cheat sheet for the summer staff to look at when they get last minute resistrations. Since I do not work all summer, I don't like to let the records sit there and be totally out of compliance. Granted, it's NJ's requirements, but i'll attach it as you may find it helpful.

Vaccine Requirements for grades MS.doc

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