4 The Oklahoma Nurse December 2017, January, February 2018 Improving Oklahoma’s Adolescent Vaccination Rate Steven Crawford, MD, FAAFP It’s crucial to help adolescents start the New Year as healthy as possible by seeing that they’re up to date on their vaccinations. As you know, the Centers for Disease Control and Prevention (CDC) recommends teens receive at least four vaccines, including quadrivalent meningococcal conjugate vaccine (MenACWY); human papillomavirus vaccine (HPV); tetanus, diphtheria and pertussis vaccine (Tdap); and influenza (flu) vaccine. 1,2,3 Despite these recommendations, Oklahoma immunization rates are dismally low, with rates for three of four vaccines falling below the national averages. 1 This means thousands of our teens are under-protected from serious infectious disease, including meningococcal meningitis. Though uncommon, it is potentially deadly and can take a life in as little as 24 hours. 4 It’s also a disease for which teens are at increased risk, likely due to everyday behaviors like sharing water bottles and kissing. 5,6 Adolescents need two doses of MenACWY to help protect them during the years they are at increased risk. According to the CDC, in 2016 just 74% of adolescents in Oklahoma received at least one of the two CDC-recommended doses. Given the national second-dose rate (39%), it’s safe to deduce most of our state’s teens are underprotected. 1 Oklahoma is ranked the 16h lowest out of all U.S. states/jurisdictions for MenACWY vaccination coverage. 7 All HCPs Play an Important Role A 2014 study published in The Journal of the Oklahoma State Medical Association found that MenACWY and Tdap vaccination rates in Oklahoma were consistently lower than national estimates. 8 Interestingly, the study uncovered health care providers (HCPs) in Oklahoma are less likely to recommend adolescent vaccines compared to HCPs in the rest of the U.S. (based on a state-wide household survey). 8 The authors concluded HCPs can help improve vaccination rates by giving strong recommendations and encouraging staff in the entire practice, not just clinicians, be trained to communicate the benefits of vaccination. 8 How Nurses Can Help Boost Teen Vaccination Rates Nurses can play a pivotal role in helping increase state vaccination rates, especially by taking the following actions: • Use every patient interaction – not just wellness visits – as an opportunity to make clear vaccination recommendations and/or administer vaccines • Stay up-to-date on the latest Childhood and Adolescent Immunization Schedule from the CDC (the schedule now has an added 16-year-old immunization visit, highlighting this as a crucial age for vaccination to HCPs and parents) • Present Tdap, MenACWY and HPV as a standard “bundle” of adolescent immunizations • Ask medical assistants to check the immunization registry at every visit, to help determine the patient’s immunization status for recommended vaccines • When possible, administer vaccines early in the visit • Keep updated provider-level “report cards” with adolescent patient vaccination rates to look for areas of improvement • Lead vaccination campaigns at schoolbased health centers • Be prepared to listen to patient questions about vaccine safety and address concerns • Reference the “Guide to Community Preventative Services (The Community Guide)”, a resource for scientific, evidencebased recommendations and strategies that work to improve adolescent coverage rates 9 Lastly, the American Academy of Family Physicians Foundation (AAFP Foundation) launched Highlight on VACCINATIONS 4 TEENS to address under-vaccination and provide HCPs with tools to conduct these important conversations with patients. Available resources include videos; reminder emails, letters, text messages and postcards; website and social media posts; in-office vaccination reminder posters; and personal testimonials from individuals impacted by vaccine-preventable diseases. Our state’s AAFP Chapter also launched the program to its members. You can learn more and find the materials here: www.aafpfoundation.org/ vaccinations4teens. By combining these steps and tools, nurses can play an integral role in boosting teen vaccination rates. Thank you for all that you do each and every day. Steven Crawford, MD, FAAFP is the Chair of Family Medicine in the Department of Family and Preventive Medicine at OU College of Medicine. References: 1. Centers for Disease Control and Prevention. (2017). National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2016. Retrieved from https://www.cdc. gov/mmwr/volumes/66/wr/mm6633a2.htm?s_ cid=mm6633a2_w. Accessed September 12, 2017. 2. United States Census Bureau. (2013). Age and Sex Composition in the United States. Retrieved from https://www.census.gov/topics/population/ age-and-sex.html. Accessed April 4, 2017. 3. Centers for Disease Control and Prevention (2015). Flu Vaccination Coverage, United States, 2015-16 Influenza Season. Retrieved from http://www.cdc.gov/flu/fluvaxview/coverage- 1516estimates.htm. Accessed May 10, 2017. 4. World Health Organization. (2015, February). Meningococcal Meningitis. Retrieved from http:// www.who.int/mediacentre/factsheets/fs141/en/. Accessed May 30, 2017. 5. Centers for Disease Control and Prevention. (2016, April 18). Meningococcal Vaccines for Preteens, Teens. Retrieved from https://www. cdc.gov/features/meningococcal/. Accessed May 10, 2017. 6. Centers for Disease Control and Prevention. (2012, March 15). Meningococcal Disease. About: Causes and Transmission. Retrieved from http:// www.cdc.gov/meningococcal/about/causestransmission.html. Accessed May 30, 2017. 7. Centers for Disease Control and Prevention. (2017). TeenVaxView. Meningococcal conjugate (MenACWY) vaccination coverage among adolescents 13-17 years by State, HHS Region, and the United States, National Immunization Survey-Teen (NIS-Teen), 2016. Retrieved from: https://www.cdc.gov/vaccines/imz-managers/ coverage/teenvaxview/data-reports/menacwy/ reports/2016.html. Accessed September 12, 2017. 8. Naifeh MM, Roberts JR, Margolis B. et al. (2014). Adolescent vaccination in Oklahoma: a work in progress. The Journal of the Oklahoma State Medical Association, 107(9-10), 510-516. 9. Department of Health & Human Services. The Guide to Community Preventive Services. Retrieved from https://www.thecommunityguide. org/. Accessed April 4, 2017.
December 2017, January, February 2018 The Oklahoma Nurse 5 Nurse of the Day: Lessons Learned Jennifer O’Connor, MS, RN, CFCN, CNE,ONA Region 2 Mindy Thompson, DNP, RN, ONA Region 3 You have that one friend, the one who gets you into things? That would be Mindy. You have that other friend, the one who wants to write an article about it? That would be Jennifer. We all need friends like this! So, we trekked to the capital for Nurse of the Day. A minor adventure ensued, one that opened our eyes and taught us to always wear comfortable shoes. Pro Tip #1: Know Before You Go. Register through the ONA website, read all the info, choose your day, plan your stay. Plan for a good night’s rest and a short, low stress drive in the morning to ensure pictures with legislators will be free of dark circles under the eyes. One thing we did not know is that legislators are at the capital all day Tuesdays and Wednesdays and ½ days Mondays & Thursdays. The Thursday before Spring Break was probably not the best time to be underfoot. Pro Tip #5: Know your Self (Care). Take time to have some fun and always wear comfortable shoes! When you choose fancy shoes to match your professional attire, make sure they are comfortable! You will be walking, so remember Maslow and care for your physiological foundation. Take some pictures – the capital building has beautiful marble, impressive art, and stunning architecture (even when under construction). Pick up a new purse at the gift shop. Go to Mutt’s Hot Dogs for lunch – it is excellent, if not healthy! You Have Questions? Pro Tip #6: Know how to try something new. Just go! If we can do it, so can you! We Have Answers! Pro Tip #2: Know Your Audience. Find out who your legislators are. Do you know your senator and representatives? Even after checking the Oklahoma Legislature web site, one of us (we’re not telling who) had the wrong name. There’s nothing like making a good first impression! Unsurprisingly, the staff nurse was an excellent resource. After an introduction on the floor of the House and Senate, we met our legislators, had photo ops, and received certificates suitable for framing. A definite spirit of friendly competition exists between the House and Senate: the House’s certificate is larger; however, the Senate provides better snacks. So, depending on your priorities… Pro Tip #3: Know the Issues. Watch your email for Legislative Alerts from ONA and find something you are passionate about to discuss with your legislator. While we reviewed the emailed Legislative Alerts from ONA, but failed to check the legislative calendar, so we were not knowledgeable about the bills discussed that day. This trip was a toe-in-the-water experience; we probably looked like a couple of wide-eyed kids (“Everyone is so dressed up!” “Look at those heels, must be uncomfortable!”). Next time, we will know the issues and speak with our legislators about them. Our representatives want to hear from us—we need to be sure we have something to say. Where do I start? Who are my legislators, anyway? Where could I stay the night? What do I talk to them about? http://www.oklahomanurses.org/Main-Menu- Category/Events/Nurse-of-the-Day Everything you need to know http://www.oklegislature.gov/FindMyLegislature. aspx Scroll down, our US congresspersons are listed first Colcord Hotel, Aloft, Sheraton, Hampton Inn, & Ramada are all near downtown Watch for emails from ONA (Legislative Alerts), check the calendars for the State House and Senate at http://www.oklegislature.gov/index.aspx, contact our lobbyist, Vicki White-Rankin. Pro Tip #4: Know You’re a Pro. Dress appropriately and use your best manners. Remember, you are a guest in the Legislature and represent the profession. Nurse of the Day is a wonderful opportunity to share educated and substantiated viewpoints in a professional manner. We were sure to smile and speak politely to our legislators, even when they held viewpoints vastly different from our own. When you go, remember: you are representing all of us, so we are counting on you to make a good impression. No pressure! After locating the awesome Nurse of the Day parking space we realized we should have worn lab coats. Now, surely this information was provided to us, but in our excitement to witness the democratic process first-hand, we just overlooked it. So, now YOU know. Wear a white lab coat. And you don’t want those fancy dressed legislators to make you look bad, so dress well. You know what they say? When in Rome… After your life-changing experience at the Capital, be sure to send a thank you note to your representatives. One of us may or may not have done this (again, no names!). However, learn from our mistakes! We are better together. 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