2020 Best Practices Form MOBI TIES Program * MOBI TIES Trainer Name * Trainer Email * Site Name * VFC or Assign Number (See the assessment portion of your IQIP Manual) * Date of Planned Program * BEST PRACTICES FOR OFFICE OPERATIONS 1. Will the practice have an IQIP measurement? Yes No Had one in the past year Date of planned IQIP Can the practice expand on your decision not to have an IQIP measurement? 2. Is the practice a VFC provider? Yes No Don't know Provide information on becoming a VFC provider in your presentation. 3. Does the practice provide a current vaccine information statement (VIS) to parents prior to an immunization ? * Almost Always Frequently Sometimes Rarely Never Don't know Reinforce "It's Federal Law" in your presentation. 4. Does the practice have a written plan for protecting vaccines in case of a power outage? Yes No Don't know If no, reinforce sample emergency plans in your presentation. 4. Does the practice use the ImpactSIIS Registry to look up immunizations? Yes No No, but wants to start Don't know What features of ImpactSIIS do they use? (check all that apply) Look up past immunizations Enter vaccines as given Enter historical shot records Other Why not? Provide the practice information to sign up during your MOBI presentation. 6. Does the practice check vaccine status at every office visit? * Almost always Frequently Sometimes Rarely Never Don't know 7. Does the practice have materials available to address vaccine concerns? * Almost always Frequently Sometimes Rarely Never Don't Know Consider including the vaccine hesitancy module to your presentation and highlight the refusal brochures. BEST PRACTICES FOR INCREASING VACCINE RATES 8. Does the practice use an immunization REMINDER system for every patient? * Almost always Frequently Sometimes Rarely Never Don't know 9. Does the practice use an immunization RECALL system for every patient? * Almost Always Frequently Sometimes Rarely Never Don't know 10. Does the practice have someone they consider their "go to" person for vaccine questions? * Yes No Don't know Name of "Go To" Person (ensure this person attends the presentation): 11. Does the practice give all vaccines that are due, regardless of the number of injections? * Almost Always Frequently Sometimes Rarely Never Don't know 12. Does the practice allow shots to be given to children (for TIES, adolescents) with minor illnesses like colds, diarrhea or low-grade fever? * Almost Always Frequently Sometimes Rarely Never Don't know Reinforce "Valid Reasons to Withhold Vaccine" slide in your presentation. 13. Does the practice allow patients to come in for immunization only nurse visits? * Almost Always Frequently Sometimes Rarely Never Don't know 14. Does the practice give age-appropriate vaccines even when no vaccine record is available? * Almost Always Frequently Sometimes Rarely Never Don't know 15. Does the practice use combination vaccines? * Almost Always Frequently Sometimes Rarely Never Don't know 16. Is the practice working on any sort of quality improvement project or IQIP strategy that would be helpful for me to know? Yes No Notes: 17. Does the practice have any other specific vaccine-related issues they'd like you to address in your presentation? Trainer Notes (section for trainer to type notes and reminders for their presentation) If you are human, leave this field blank.
