www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 33 troversy, in order to allow them to help allay the fears of their patients’ caregivers or parents. No increased risk of adverse effects has been noted following the administration of MMR vaccine in patients who are already immune to the diseases contained in the vaccine (CDC, 2016). DESCRIPTION OF MMR II PRODUCT The MMR and MMRV vaccinations are available in a freeze-dried powder form and are reconstituted with preservative-free sterile water immediately before injection. The vaccines contain small amounts sor- bitol, sodium phosphate, sucrose, sodium chloride, hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, and neomycin (Merck, 2017-1). VACCINE STORAGE AND ADMINISTRATION The MMR vaccine can be stored in the refrigerator at temperatures of 36°F to 46°F (2°C to 8°C), or in the freezer, between -58°F and +5°F (-50°C and -15°C). Diluents may be stored in the refrigerator or at room temperature, as appropriate. MMR vaccine should be protected from light. Once recon- stituted, the MMR vaccine must be used within eight hours. Reconstituted vaccine not used within these timeframes must be discarded. To administer the MMR vaccine, 0.5 mL should be injected subcutaneously in the upper arm subcutaneous tissue (Merck, 2017-1). SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 10. The MMR vaccine contains all of the fol- lowing components EXCEPT: a) Neomycin. b) Sorbitol. c) Gelatin. d) Thimerosal. STRATEGIES FOR IMPROVING VACCINATION RATES Despite generally high vaccination rates in the U.S., gaps in care exist. HCPs must remain diligent in encouraging vaccinations to maintain population immunity against contagious diseases. Several strategies have been utilized to maximize immuni- zation rates among the U.S. populations. Maintaining adequate records of immu- nizations is critical to ensure that patients receive vaccinations at appropriate intervals. Immunization records must be accurate and include all necessary information on the vaccine administered to comply with state and local laws. Records should be updated as new immunizations are administered (CDC, 2015-2). The maintenance of adequate immuniza- tion records can be simplified by the use of immunization information systems, or immu- nization registries. These computerized data- bases have the ability to record all doses of vaccines administered by participating pro- viders. Immunization information is collected from various providers to create a single offi- cial immunization record for each patient. This allows for consolidated records that can be used in patient care. Immunization infor- mation systems have the ability to exchange information with HCPs who administer immunizations to ensure vaccines are given in a timely manner, consolidate records, and increase efficiency of immunization programs (CDC, 2015-2). Recommendations of a HCP can be a pow- erful tool to help motivate patients to comply with immunization schedules. Some patients are simply unaware that they are missing vac- cinations, or they may not understand that return visits to complete vaccination sched- ules are necessary. Patients are more likely to receive timely vaccinations if they are encour- aged to do so by a HCP (CDC, 2015-2). Reminder messages to patients can help them comply with immunization sched- ules. Reminders that vaccines are due soon, or are past due, can help improve adherence to recommended immunization schedules. Providers can utilize automatic systems to help them notify patients when they are due or past due for vaccinations. This simplifies the process and increases vaccination rates (CDC, 2015-2). Reducing the number of missed opportu- nities to vaccinate patients is also critical to improve vaccine schedule adherence. There are several reasons why opportunities to vac- cinate may be missed. Providers may be reluc- tant to administer several vaccinations in one visit, despite the lack of evidence against this practice. Inability to access immunization records during the patient’s visit has also been cited as a reason for missed opportunities to vaccinate. Policies can also create missed opportunities for immunizations, such as only providing vaccinations at annual well-child visits. Ensuring that immunization records are available at all patient visits and that rec- ommendations are followed for administering multiple vaccinations or vaccinating during mild illness can help improve overall vaccina- tion rates (CDC, 2015-2). STRATEGIES FOR IMPROVING VACCINATION RATES Reducing barriers for patient immuniza- tions can also impact immunization rates across populations. Physical barriers to immunization, such as inconvenient office hours for working adults and long wait times, can prevent patients from seeing a HCP for immunizations. Providers must assess the needs of their patient populations and take steps to minimize the number of physical barriers for the timely receipt of vaccinations (CDC, 2015-2). Cost can also be a significant barrier to vac- cination for many patients. HCP should use federal resources such as the Vaccines for Children program, as well as state-funded resources, to minimize the cost of vaccina- tions to patients to maximize immunization rates (CDC, 2015-2). Psychological immunization barriers can also play a role in reducing adherence to vac- cination schedules. Fears of immunizations, previously unpleasant immunization experi- ences, and reluctance to listen to criticism for missed appointments can cause patients to delay vaccinations. Concerns about the safety of vaccinations and potential adverse reactions can also be considered a barrier to immuni- zation. Overcoming these barriers requires a collaborative and an open line of communica- tion between the HCP and the patient. HCPs should be prepared to provide knowledge and resources on vaccine safety, as well as recom- mendations in a supportive environment to help ease patients’ concerns (CDC, 2015-2). CONCLUSION Vaccination against measles, mumps, and rubella is the best method for preventing the spread of these contagious and poten- tially serious conditions. Immunization |  CONTINUING EDUCATION