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can protect myself. Get vaccinated.” We designed brochures about Tdap and influenza vaccination that match the posters and sit at the check-in stations for all of the doctors company-wide in our multispecialty group. (Practices can also make use of existing, publicly available brochures and other educational materials on adult immunization.) Parents are told to get vaccinated against pertussis and influenza, no matter how, the sooner the better. Most parents of my patients ask if we will vaccinate them on the spot to save them the trouble of going elsewhere. My answer: “Of course.” We file insurance claims for parents who wish us to do so or accept cash. My nurse and the rest of my staff are totally on board for the tiny extra bit of work. Those of you who work closely with other offices can go a step further if you dare. In my group, I have spoken at the annual meeting of the obstetrics/gynecology department and developed a process for educating the Ob/Gyn staff to get them to vaccinate adult contacts preconception and, failing that, before the baby is born. With the June 2011 vote by the Advisory Committee on Immunization Practices to recommend immunization with Tdap during pregnancy, our obstetricians are likely to begin vaccinating unimmunized expectant mothers during second and third trimester visits as well. I also travel to other pediatric offices within our group, educating the staff there to start vaccinating adults company-wide. This is my passion. If you are part of a large group, find someone in your ranks who will make it theirs. Maybe that someone should be you? My challenge to you is this: Don’t just set this newsletter aside after you read it, with the promise to think about it later. Instead, take out a piece of paper now, then jot down a few notes as you read. Once you are finished, spend 5 minutes making a plan. Talk to your associates on your next workday and implement that plan. Whether you simply educate and refer adult contacts or vaccinate them against pertussis on the spot, we can make a difference in limiting the incidence of this life-threatening and preventable disease, 1 parent and 1 family at a time. Sincerely,
Alix Casler, MD, FAAP 2
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ambitious cocooning program to help prevent both pertussis and influenza in 2006, following release of the ACIP guidelines on pertussis prevention and a pertussis outbreak in the county. Today, upwards of 95% of eligible new parents have been immunized with Tdap.The program involves the entire 12-member staff, from the receptionist to the billing specialist. Initially, the practice’s personnel were reluctant to embrace the idea of vaccinating adults, given the expanded duties that a full-scale program requires. “Our goal was to get the entire staff committed to the idea of cocooning, and that really involved a cultural change,” said Brian D. Patterson, MD. Showing his employees statistics about the high rate of pertussis transmission didn’t convince them of the critical importance of cocooning; sharing compelling stories of vaccine-preventable deaths in children, however, did.“Telling stories and watching videos of actual cases made emotional connections with staff,” Dr. Patterson said. Large practices may want to identify a staff member who will serve as the office vaccine champion.That individual should have strong leadership, organizational, and communication skills and be versed in (or interested in learning about) vaccines, vaccine-preventable diseases, and vaccine purchasing. At Patterson and Tedford Pediatrics, the office manager developed expertise in vaccine procurement and immunization and now coordinates their expanded immunization program. How can I minimize potential liability? Experts recommend that pediatricians first contact their malpractice carrier to see if their insurer will cover immunization of close adult contacts.3 If the answer is yes, request written verification of that coverage. Some practices obtain policy riders that specifically cover immunization of key adult contacts of patients with Tdap and influenza vaccines. As with vaccination of pediatric patients, the steps needed to ensure safe vaccine administration apply: inquire about allergies, medications, and recent or present illness; distribute and discuss the most current Vaccine Information Statement (VIS) from the Centers for Disease Control and Prevention (CDC); and document the immunization according to federal and state requirements (see the checklist on this page).4 Practice management expert and pediatrician Richard H.Tuck, MD, Medical Director of Quality Care Partners in Zanesville, Ohio, suggests that pediatricians who inquire about adult immunization with their carrier “ask
How to Immunize Parents in the Pediatric Setting
Cocooning vaccination checklist 4 ✔ Assess Tdap status ✔ Check for contraindications and precautions ✔ Discuss vaccine benefits and risks ✔ Provide the current Vaccine Information Statement (VIS) ✔ Solicit questions and discuss concerns ✔ Have the adult sign a waiver or consent form if required ✔ Document the encounter – Edition and date of VIS – Date vaccine administered – Name, title, and office address of person administering vaccine – Vaccine specifics (manufacturer, lot number, expiration date) – Site and route of vaccine administration ✔ Tell the adult whom to notify if a reaction occurs ✔ Comply with adverse event reporting requirements
‘How do I do it?’ not ‘Can I do it?’ You need to approach it very positively.” When Norman (Chip) Harbaugh, Jr., MD, of Children’s Medical Group in Atlanta initially inquired about vaccinating adults in 2007, his carrier—a leading nationwide provider of medical malpractice insurance—told him that he would be covered only for influenza immunization of parents or household contacts of the office’s patient. In 2009, the company extended coverage to Tdap immunization of parents and household members.“Their position is that the main purpose of giving flu and Tdap immunizations to these particular adults is the health of the pediatric patient,” said Dr. Harbaugh. The insurer requires the practice to keep a brief medical record that includes a standard history and consent form for each adult vaccinated. Giving influenza and Tdap vaccines to certain adults is a narrow exception to a policy that otherwise excludes treating adults, according to Dr. Harbaugh.“Our insurer advised me that while I can immunize an adult against influenza, I cannot give oseltamivir to an adult who has influenza. Doing so would be considered treating an adult and would not be covered.” At Willows Pediatrics in Connecticut, the providers made a single phone call to their malpractice carrier, who judged the risk of