Case study: Recall and reminders lead to record immunisation rates

When busy mum of three Makere Rolleston heard about a friend’s child who’d been ill for days with a rotavirus, she breathed a sigh of relief that her baby girl, Te Aorewa, was unlikely to suffer the same fate.

Six-month-old Te Aorewa has been immunised on time, and since July 2014 this includes protection against rotavirus.

‘I’m glad Te Aorewa has had the rotavirus vaccine. It was horrible hearing what my friend’s child went through, the vomiting, diarrhoea, and sunken eyes.

‘There are too many diseases out there. I want the best for my kids. If they are healthy they have the best start in life, it sets the foundation to help them learn and grow,’ says mum Makere.

Te Aorewa received her vaccines at the Baymed Medical Centre in Mt Maunganui. Between the centre and another in Papamoa, Baymed has achieved a 100-percent coverage rate with all eight month old babies enrolled in the practices completing their primary course of immunisation (six weeks, three and five months) on time.

That exceeds the national target of 95 percent of infants aged eight months immunised on time by December 2014.

Mum Makere says it helps that the practice sends her a reminder before her children’s immunisations are due.

‘I’m busy with three kids and working part-time. Sometimes I forget when they are due.’

As Immunisation Champion for the two medical centres, it’s the job of Registered Nurse Claire Adams, to help busy mums like Makere by offering a reminder to bring their children in for their immunisations.

‘There is no quick fix behind achieving our 100 percent immunisation coverage rate for eight month olds. You just have to be methodical, persistent and focused on immunisation.’

Claire has a designated four-hour time slot each week where she focuses solely on either reminding parents their child’s next immunisations are due or chasing up those who have missed their last one.

‘This is where we make the gains. Previously I’d chase up parents when I had a spare moment. It was pretty ad hoc. Having that set four- hour window makes a difference.’

Claire follows the Western Bay of Plenty PHO’s Guideline on Immunisation processes and the Outreach Immunisation Referral Guideline.

The “how to guide” for general practices is the brainchild of the PHO’s Immunisation Co-ordinator Diane Newland.

It sets out the steps general practices can follow to lift their immunisation coverage rates. By timely recall of children for their immunisations and referring children that get behind to the Outreach Immunisation Service we will see better coverage and protection for the community,’ says Diane.

At Baymed, Registered Nurse Claire Adams sends a letter or text to families a fortnight before the baby’s immunisation is due. This is followed up with a phone call and further text if necessary. And through the practices computer recall system, Claire keeps tabs on babies and children who are overdue. Alerts pop up on the computer screen. This is cross referenced with the National Immunisation Register (NIR).

‘I probably deal with about 25 recalls a week – those babies that have missed their immunisation on time as well as those that are several weeks overdue. It requires quite a bit of time chasing people up. It is a matter of phoning people up, listening to their concerns and providing them with the right information to make an informed choice.

‘Parents are busy people, often we hear they have been unable to make that scheduled three month immunisation because baby’s been sick or an older sibling has been unwell. And sometimes people simply forget,’ says Claire.

When they are overdue by a month, Claire refers them to the PHO’s Outreach Immunisation Service where the immunisation nurses go into homes.

The outreach service also receives referrals from other parts of the health sector such as NIR, Plunket, Tamariki Ora, the hospital’s paediatric service and outreach services in other regions.

Sometimes the nurses working for the outreach service might just talk to the family about immunisation. A phone call from the service is often enough to prompt Mum to make an appointment at the GP, which is the preferred option.

‘If parents are nervous about vaccinating their child, it often helps to talk to them in a friendly manner in their own environment. The nurses keep their immunisation gear in the car in case the family decides to proceed,’ says Claire.

Claire says it really takes a team approach to making sure babies enrolled with the medical centre, like Te Aorewa are immunised on time.

‘It starts right back with the midwife, providing new mums with the right immunisation information from birth. Then when mum or dad brings baby in for its six week check up, we work closely with our doctors to try and make sure they don’t leave without at least being well informed and hopefully those first six week immunisations.’

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