Inform
Once a patient is identified as needing a routine vaccination, is there a best message (SMART PHRASE) to encourage vaccination?
The working group developed suggested practices to approach pediatric patients who may be undervaccinated, given the following scenarios.
- Child appears to be behind, or it’s unclear, and the vaccine is NOT available to give in the ED
- Child has primary care provider → (To the primary care provider via secure platform) “We are concerned that this child may be behind on some of their vaccines. Please review their vaccine history.”
- Child does NOT have primary care provider → (To caregiver) “It’s important to be up-to-date on your child’s vaccines, which help prevent serious illness. To find a health center for vaccines and other care, please check: https://findahealthcenter.hrsa.gov/”
- Child appears to be behind, or it’s unclear, and the vaccine IS available to give in the ED
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- Inclusion criteria for vaccination in the ED: Child is due for a vaccine that is available in this ED currently
- Exclusion criteria for vaccination in the ED:
- The child has a contraindication or precaution to that vaccine (See CDC web page)
- Legal guardian is not present or is not able to consent [Legal guardian or child is unable to consent to a vaccine because of 1) major trauma, intoxication, altered mental status, or critical illness; 2) in police custody or incarceration; 3) a psychiatric chief complaint or hold; 4) other reason]
- Legal guardian does not give consent to vaccinate in the ED at current visit
Process for offering vaccination in the ED, if available
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- Sometime before anticipated discharge, present suggested vaccine messaging: “After review of your child’s vaccine history, your child is due for x vaccine. We have that vaccine here in the Emergency Department and are able to give it to them. Here is some information about that vaccine (provide Vaccine Information Statement).”
- Return later “Do you have any questions about the vaccine?” Ask if they will accept vaccine in the ED now
- If will accept, administer vaccine, document, etc.
- If will not accept – see table below
For patients who do not accept vaccine in the ED at this visit, we suggest the following process.
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- Child has primary care provider → (To the primary care provider via secure platform) “We are concerned that this child may be behind on some of their vaccines. Please review their vaccine history.”
- Child does NOT have primary care provider → (To caregiver) “It’s important to be up to date on your child’s vaccines, which help prevent serious illness. Find a health center for vaccines and other care, please check: https://findahealthcenter.hrsa.gov/”
- For COVID-19 specific circumstances (can be used with influenza as well)
- When child has not received COVID-19 vaccine
- If ED offers COVID-19 vaccines, say “We can provide the COVID-19 vaccine as part of your child’s care in the Emergency Department today. Would you like your child to receive it?”
- If ED does not offer COVID-19 vaccine and they have a primary care physician, say “Please see your primary care physician to ask about the COVID-19 vaccine.”
- Example messages to encourage COVID-19 vaccines: Scripts for provider messaging OR Flyers
- COVID-19 vaccines have been shown to prevent severe illness in children. The Centers for Disease Control, American Society of Pediatrics and the American College of Emergency Physicians recommend COVID-19 vaccines for all children older than XXX.
