KEYWORDS:
VFC site visits, quality assurance, protocol for follow-up

BACKGROUND:
In 2001, Public Health-Seattle & King County conducted 45 quality assurance (QA) assessments of health care providers as required by the federally-funded Vaccines for Children (VFC) program using a CDC-developed check list to evaluate immunization practice. We identified areas of repeated non-compliance with VFC requirements including vaccine storage and accountability; administration and documentation; and access to resources and training. We also encountered improper storage temperatures and incidents that damage vaccine. No protocols were previously available describing appropriate public health follow-up procedures for specific problems identified.

OBJECTIVE:
To develop a follow-up protocol to guide our interventions with VFC providers who are non-compliant with immunization practice standards.

METHOD:
We developed a Site Visit Follow-up Protocol (SVFP) to guide interventions with VFC providers non-compliant with immunization practice standards. Problems were identified through the QA assessments, review of monthly accountability and storage reports, and reports of vaccine damage incidents. Results of the SVFP were graded A-E using standardized criteria, “A” signifying that no problems and “E” indicating violations that could result in significant adverse health effects for the vaccinee and/or major costs due to vaccine damage. Specific follow-up actions were defined and implemented for each grade.

RESULT:
We will report on our first year of experience using the SVFP, including the range of compliance and immunization practice deficiencies documented and addressed, and the results of the interventions applied through the SVFP.

CONCLUSION:
Any “risk-factors” for poor compliance will be described. The potential usefulness of this protocol for other Local Health Jurisdictions will be discussed.

LEARNING OBJECTIVES:
1. Identify one immunization practice violation each for grades B through E on the follow-up protocol.
2. List actions recommended for Public Health to follow-up with providers who have the most serious immunization practice violations (letter grade = E).