Berling Ingrid, Stephenson Jody, Cashman Patrick, Loten Conrad, Butler Michelle, Durrheim David
John Hunter Hospital, Australia.
Australas Emerg Nurs J. 2012 Feb;15(1):37-44. doi: 10.1016/j.aenj.2011.12.002. Epub 2012 Feb 9.
Every health service presentation of a child should be considered an opportunity to ensure optimal immunisation. Measures to limit missed opportunities for vaccination in local emergency departments (ED) should reflect the scale of opportunity and parental support of immunisation service delivery strategies.
The vaccination status of every child aged less than seven years that presented to a tertiary hospital ED over a three month period was identified using the Australian Childhood Immunisation Register (ACIR). Contra-indications to vaccination were determined from medical records. A telephone survey or posted survey was conducted with parents of eligible children to confirm ACIR status and whether they would have consented to receiving vaccinations during their presentation. ED records were reviewed for vaccination history recording and ACIR records were reviewed, after interview, to confirm parental reports that initial ACIR status was incorrect.
Nine per cent (215/2399) of children were identified as incompletely vaccinated according to ACIR. Forty-seven children were excluded. Of the remaining 168 children, 95 parents (57%) participated. Thirty-eight children had no contra-indications and their parents would have consented to vaccination during their ED presentation. The vaccination status of 82% (78/95) was recorded in ED records, but was incorrect in 35 cases. Forty parents indicated that the ACIR record was incorrect and this was confirmed in 36 cases (90%).
There were missed opportunities to vaccinate a small proportion of children in ED. Parents provided a more accurate timely history of immunisation status than ACIR and thus ED staff should ensure that parents are always asked whether their child is fully vaccinated and provide or encourage vaccination.
儿童每次就诊于医疗服务机构时，都应被视为确保最佳免疫接种的契机。限制当地急诊科（ED）疫苗接种错失机会的措施应反映机会规模以及家长对免疫接种服务提供策略的支持情况。
利用澳大利亚儿童免疫接种登记册（ACIR）确定在三个月期间就诊于一家三级医院急诊科的每名七岁以下儿童的疫苗接种状况。从病历中确定疫苗接种的禁忌症。对符合条件儿童的家长进行电话调查或邮寄调查，以确认ACIR状态以及他们在就诊期间是否会同意接种疫苗。审查急诊记录以查看疫苗接种史记录，并在访谈后审查ACIR记录，以确认家长报告的初始ACIR状态是否有误。
根据ACIR，9%（215/2399）的儿童被确定为疫苗接种不完全。47名儿童被排除。在其余168名儿童中，95名家长（57%）参与调查。38名儿童无接种禁忌症，其家长在急诊就诊期间会同意接种疫苗。急诊记录中记录了82%（78/95）的疫苗接种状态，但其中35例有误。40名家长表示ACIR记录有误，36例（90%）得到证实。
急诊科存在错失部分儿童疫苗接种机会的情况。家长提供的免疫接种状态历史比ACIR更准确及时，因此急诊工作人员应确保始终询问家长其孩子是否已完全接种疫苗，并提供或鼓励接种疫苗。
