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immunization smartphrases or dotphrases

  • 1.  immunization smartphrases or dotphrases

    Posted 04-15-2025 11:31

    Hello,  I am wondering what your clinics use for documenting immunizations?  Our immunization standard work includes a waiting time of 15 minutes for any child 11-18 years of age and this gets documented in the smartphrase.  I am not crazy about the current immunization smartphrase we use and am curious if other clinics have any they could share.  I am looking for a smartphrase that would include the vaccines given (in a drop down) and option to pick VIS's that were given (in a drop down), but also want to capture that the patient did or did not agree to wait.  I will most likely need to create my own, but wanted to reach out in case anyone had some information on what they use! Thanks in advance!

    Erin Riesenweber

    ThedaCare RN Clinical Educator

    ThedaCare Vaccine Education Specialist



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    Erin Riesenweber BSN RN
    ThedaCare
    Seymour WI
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  • 2.  RE: immunization smartphrases or dotphrases

    Posted 04-15-2025 15:27

    Hello Erin, we have a policy that recommends patients wait 15-30 minutes after a vaccine. We do not specifically document if or for how long a patient waited. We use an Express Lane and have created vaccine screening SmartForms specific for pediatric and adult vaccines. Once the vaccine screening SmartForms are completed, and there are no contraindications or precautions, staff pull in the responses to the questions into the note using a SmartPhrase. The last sentence notes that any contraindications and precautions were discussed with the provider and the vaccine was/was not given as directed.

     

    Thank you,

     

    J.J. Peacock, MSN-Ed., RN, AMB-BC

    Professional Development Generalist, Sentara Ambulatory Services Division

    Co-Chair AAACN Staff/Patient Education SIG

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

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    Disclaimer:

    This electronic message and its contents and attachments contain information from Sentara Health and is confidential or otherwise protected from disclosure. The information is intended to be for the addressee only.
    If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify us immediately and destroy the original message and all copies.





  • 3.  RE: immunization smartphrases or dotphrases

    Posted 04-16-2025 01:07
    Hi Erin,

    We document the immunization in the MAR. Its ordered in Epic as clinic administered medication by the provider first. Once the order populates we document in the MAR which requires dose, site, NDC, lot number, exp number etc. We also do a smartphrase, but it's brief and refers back to MAR.

    Hope this helps,

    Marta RN BSN AMB-BC, IBCLC
    New York Presbyterian OB/GYN





  • 4.  RE: immunization smartphrases or dotphrases

    Posted 04-17-2025 09:05

    Hi Marta,

    Do you mind sharing, does the MAR documentation automatically link to the state's vaccine records?

    We are using the Epic tab titled Immunizations to document administration of the ordered vaccine, but this tab does not have functionality to record diluents. It would be ideal to be able to record in the MAR to capture that information, as well as promote consistency in documentation.



    ------------------------------
    Emma Alonso RN, MSN, CNL
    USFTGP Physician Services Educator
    TGMG Administration
    813-844-8690 - Office

    emmaclarke@usftgp.org
    ------------------------------



  • 5.  RE: immunization smartphrases or dotphrases

    Posted 04-17-2025 09:09

    Hello Emma,

    Before we transitioned to the MAR for vaccines, we documented our vaccines in the Immunization tab. Part of the build was to have the VIS date auto populated, but to be confirmed. We also added VFC eligibility and date of verbal consent to the documentation as well. Now that the vaccines are in the MAR, this is built in that documentation.

     

    Thank you,

     

    J.J. Peacock, MSN-Ed., RN, AMB-BC

    Professional Development Generalist, Sentara Ambulatory Services Division

    Co-Chair AAACN Staff/Patient Education SIG

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

    Shape  Description automatically generated with medium confidence

     

    Disclaimer:

    This electronic message and its contents and attachments contain information from Sentara Health and is confidential or otherwise protected from disclosure. The information is intended to be for the addressee only.
    If you are not the addressee, any disclosure, copy, distribution or use of the contents of this message is prohibited. If you have received this electronic message in error, please notify us immediately and destroy the original message and all copies.





  • 6.  RE: immunization smartphrases or dotphrases

    Posted 04-17-2025 14:35

    Thank you so much!!!



    ------------------------------
    Emma Alonso RN, MSN, CNL
    USFTGP Physician Services Educator
    emmaclarke@usftgp.org
    ------------------------------



  • 7.  RE: immunization smartphrases or dotphrases

    Posted 04-17-2025 16:30
    Hi Emma,

    Thanks for pointing that out- routine immunizations do get documented in the immunization tab and is part of immunization registry. However, some show up in the MAR like Rhogam which is not an immunization per say. We doesn't document diluents either. I've asked some of our providers what they do and they are also not documenting diluents or for example when they give lidocaine with Nexplanon or an IUD. Honestly I feel like it should documented because the patient did get it. What if they have a reaction? Also, what about billing? I have brought this up with management recently, so will update if anything changes.

    So for clarification immunizations go in the immunization tab, however other injections typically show up in the MAR, but not always the case. Not sure if it's related to the order type?!

    Marta RN BSN AMB-BC, IBCLC
    New York Presbyterian OB/GYN






  • 8.  RE: immunization smartphrases or dotphrases

    Posted 04-17-2025 16:41

    As part of our transition of vaccines to the MAR, we have created order panels for Pentacel and Shingrix. These order panels require staff to barcode scan both vials. This will hopefully decrease errors related to administering the diluent only and enhance documentation.

     

    Thank you,

     

    J.J. Peacock, MSN-Ed., RN, AMB-BC

    Professional Development Generalist, Sentara Ambulatory Services Division

    Co-Chair AAACN Staff/Patient Education SIG

     

    Office: 434-654-4529

    Email: SJPEACOC@sentara.com | SASDClinEduTeam@sentara.com

    590 Peter Jefferson Parkway, Suite 323, Charlottesville, VA 22911

     

    RQI: RQI_SASD@sentara.com | Resuscitation Quality Improvement (RQI) (sharepoint.com)

     

    Shape  Description automatically generated with medium confidence

     






  • 9.  RE: immunization smartphrases or dotphrases

    Posted 04-18-2025 08:00

    This is so helpful, thank you Marta and J.J.! We were planning on having a pop up reminder to order the diluent in the MAR, but continue to document the main immunization within the immunization tab. However, the ability to move everything into the MAR is a very exciting possibility for our team! I will be bringing this our leaders, fingers crossed!



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    Emma Alonso RN, MSN, CNL
    USFTGP Physician Services Educator
    emmaclarke@usftgp.org
    ------------------------------



  • 10.  RE: immunization smartphrases or dotphrases

    Posted 04-19-2025 15:14

    I don't know if this will help you, since we have a self-developed EHR system, but when a clinician orders a vaccine or a patient comes in during a nursing visit and the staff create their own documentation, we have pop-up boxes for the required documentation.  We enter vaccines into our electronic inventory by the NDC code, which captures brand information, lot number and expiration date when we place the curser over the "inventory" box and scan the vaccine.  We then choose the route, site and VIS given.  With some vaccines you might give more than one VIS.  We maintain the current VIS dates on the back end, so once the VIS type is chosen the date comes along with it. This is what it looks like:



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    Lisa Duncan, DNP, MBA, RN, AMB-BC, CIC, NEA-BC
    VP, Regulatory and Compliance
    Family Health Centers of San Diego
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  • 11.  RE: immunization smartphrases or dotphrases

    Posted 04-19-2025 15:20

    I forgot to add that with our EHR, you can add a comment if needed, but except for teens, we are no longer having patients wait after the vaccine administration.  If we hold them in the exam room it delays care for other patients, and we lose track of them if they wait in the lobby. Teens are higher risk for fainting, so we watch them.

    Also, we have a bi-directional HL7 interface with our immunization registry.  We do a nightly data dump of vaccine administration information and can receive information by "pinging" the registry for an updated record at any time.



    ------------------------------
    Lisa Duncan, DNP, MBA, RN, AMB-BC, CIC, NEA-BC
    VP, Regulatory and Compliance
    Family Health Centers of San Diego
    ------------------------------