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Story from the Field


Name of Health Department/Agency: Arkansas Department of Health
State: AR
Date Added: 11/16/2009
Themes: Communications - Priority Groups,Vaccine Planning and Administration
Issue Summary: School-located vaccine campaign in Arkansas
Description of Issue(s):

We began planning for seasonal vaccine in March to administer it in our schools in October. Then in August we found out that H1N1 vaccine would be available to us so we decided to go ahead and give the H1N1 vaccine at the same time. Our rationale was that if you give it to the kids, they won't be bringing it home to the parents and taking it out to the malls, and everywhere else. So we started planning early in the year and modified our plan as we went through the year.

Actions taken to address the issue(s): Up to this point, we've given immunizations in 670 public schools, 27 private schools, for a total of 176,434 doses of seasonal and H1N1 vaccine. The H1N1 is 76,000 doses. It looks like there's about a 60 percent uptake on the vaccine as an average--some schools are way over that and some schools are way under of course. We did this by working closely with the school administrators and the school nurses through our local health units in our 75 counties. It was basically a grassroots activity. Even though the Arkansas Department of Education encouraged these schools to work with us, we did have some local school districts that flatly said no. They got some pressure from our governor to participate with the state because it was our governor's initiative and his funding with the tobacco tax and some federal funds that made this whole activity possible. So that helped get a few more schools on board. We have about 98 percent of the schools willing to participate. We still have 431 schools and about 45 private schools to go but we're past the midpoint right now.
Outcomes that resulted from actions taken: Challenges/Barriers: The biggest challenge was giving two vaccines at the same time and keeping everything straight, which required keeping everything separate, having it all on one consent form, and printing and distributing consent forms for some 500,000 students from the central supply area out to the field.

Another challenge was managing the media in the clinics. They would show up unannounced and of course want to interview someone.

The other issue was there wasn't enough vaccine for everybody so we did prioritize, which we knew would be a problem. We said wanted to start with the youngest kids in the school and work up through the grades, with the staff last. Of course, this caused some problems because staff often wanted their vaccines first.

Another barrier was that large schools decided often to have regional clinics. A school district would have 7-8 schools in their district and they would hold one clinic in which everyone was invited and it really turned into mass flu clinic situation with all the problems that go into that.

Some schools decided they didn't want to give live vaccine on campus and we were successful in talking them into it in most of the situations. Even those places where we were successful, we had some lawsuits threatened and some physical threats. Some of the nurses reported parents showing up at the health unit, in one case one was with a gun.

Another big issue was volunteers. We had a lot of volunteers and keeping them trained as they came and went. We did pre-clinic training, but a lot of them didn't show up. Those that did show up in time were actually given the vaccine. Keeping up with paperwork, such as getting copies of nursing licenses, was sometimes a real problem.

Lessons Learned: We did learn that the school nurse is our best friend because she knows lots of volunteers and was our best help in getting some good qualified volunteers. We learned that we need to work closely with the principals and other administrators because they can resolve a lot of issues before they become problems.

We learned that next time we do this we're not going to let individual schools make some poor decisions. We're going to insist that forms go home to students and returned in time so we can plan to have enough vaccine, forms, and volunteers there. Several schools decided to tell the parents in a newsletter just to show up and that was a real issue.

We learned that we need to assign one person whose only job is to coordinate the clinic. If that person tries to give vaccine and coordinate the clinic, answer questions, solve problems, it doesn't work. If you have a larger school, you may need a second person designated just to route patients and parents from administration tables to vaccination tables and to exit tables.

We learned that we need to double check all the permission forms for which vaccine the parent wants their child to have and just because a line has something written on it, it may not be a signature. You have to read carefully what is written in the signature line. We learned to read the health history and previous vaccines carefully and to watch our product that we're using and the lot number that goes with it. Sometimes that changed in the middle of the clinic.

We learned to identify staff and volunteers with name tags and t-shirts. We learned to train all our volunteers on patient flow and all the issues that go with the different vaccines.

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