In response to the current measles outbreak in California, the CAP Hotline has received a number of calls from concerned members asking how they should manage unvaccinated patients and protect other patients in their practices.
Measles is a potentially life threatening and highly contagious disease. According to the Centers for Disease Control and Prevention, 90 percent of patients who lack immunity will contract measles if they are in close proximity to an infected individual. Additionally, the virus is communicated by direct contact with infectious droplets and through airborne transmission. It can remain viable in the air or on an infected surface for up to two hours -- contaminating the waiting rooms of doctors' offices long after infected patients have departed.
CAP Member pediatrician Dr. Eric Ball of Southern Orange County Pediatric Associates was recently interviewed by CNN about his proactive approach to managing unvaccinated patients and treating those with suspected measles. In the interview, Dr. Ball comments that much of his day is spent taking calls from concerned parents who are fearful of venturing out in public and exposing their unimmunized children. To quell the fears of parents concerned about alleged vaccination side effects, Dr. Ball shares his own child's vaccination record as part of his efforts to educate.
CAP's Risk Management & Patient Safety Department is impressed with Dr. Ball's coordinated approach to protecting existing patients, educating those with reservations, and managing parents who ultimately chose to forego vaccinations. The following are a few strategies that might benefit your office:
Establish Screening and Escalation Protocols in Your Office
Office personnel play an important role in identifying unimmunized patients and notifying providers of patients with concerning symptoms. Establish screening and escalation protocols in your office to ensure a swift and coordinated response to managing various patient scenarios.
Limit Exposure: Divert Traffic Away from the Crowded Waiting Room
Post signage on the front door of the office asking parents of unimmunized children with fever to refrain from entering the waiting room and to contact the office by phone. (Click here to see an example from Southern Orange County Pediatric Associates.) In his CNN interview, Dr. Ball explains that on several occasions, to prevent exposing other patients, he has donned mask and gloves and examined patients in their cars. Additionally, in lieu of visiting his office, some patients have chosen to communicate with Dr. Ball via secure e-mail exchange.
Manage Unvaccinated Patients - Start by Communicating Your Practice's Policy
Dr. Ball's patients receive the practice's immunization policy that powerfully communicates the practice's unwavering position that vaccines are safe and essential to preventing serious illness.
The policy also states that their providers will no longer accept new patients who refuse to immunize their children and encourages existing patients who are fearful, reluctant, or those who request a modified vaccination schedule, to discuss their concerns with their provider. Those who ultimately refuse vaccination or fail to comply with a minimum immunization schedule are asked to find a health care provider who will accommodate unimmunized patients. These patients are eventually, formally discharged1 from the practice.
Educate and Document
"Fear is often rooted in ignorance and information is the cure," says Ann Whitehead RN, JD, vice president, CAP's Risk Management & Patient Safety. "As with any situation where patients refuse recommended treatment, it is essential that physicians have a thorough and well-documented discussion with parents detailing the risks and benefits of proposed therapy, the major risks associated with refusal or delay, and any available treatment alternatives. Finally, document this discussion in the medical record."
The Los Angeles County Department of Public Health provides Frequently Asked Questions posters about measles in both English and Spanish.
Report
Measles is a reportable disease. Contact your local health department for reporting guidelines and other resources.
1 For information on how to appropriately discharge a patient from your practice to ensure continuity of care and avoid allegations of abandonment, please contact the CAP Hotline at 800-252-0555.
Authored by
CAP's Risk Management & Patient Safety Department
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.