Washington County Health Department Pilot-Tests Fluoride Varnish Application

During School Located Vaccination Clinics

Jayne Harper, Assessment & Planning Coordinator

Northeast Regional Health Office

School located vaccination clinics (SLV) are held in every public school district annually ahead of influenza season. The School-Based Dental Prevention Program (SBDPP) visits schools within the Northeast Region every other year and among other services, provides fluoride varnish application (FVA) for students. Both SLV and FVA require active parental consent.

The leadership team from Washington County Health Department decided to hold a pilot test within four county schools to offer SLV and FVA simultaneously while the health department’s nursing team was onsite. The objective was to provide FVA for 3% of eligible students within pilot schools during SLV clinics.

Before and after pilot clinics, the clerical team at the health department prepared consent forms and keyed the encounters. Health department nurses running the clinics administered both vaccines and FVA. Children were monitored after services to ensure they did not have a reaction to the vaccine and/or have anything to eat or drink for 30 minutes after FVA.

Within the four county schools participating in the pilot program, 178 students received FVA. This was 6.3% of the eligible population. Fifty-one percent of the students who received FVA did not receive influenza vaccination. Almost 9% of the students receiving FVA were age 5 and under. The combined SLV and FVA clinics were a success.

The health department’s leadership team conducted a debriefing using the Plan-Do-Check-Act (PDCA) tool and identified things that can be done in the future to improve the SLV/FVA clinics. For the clerical team, the FVA form needs to include more demographic information than the child’s name and date of birth to reduce extra work, and either create a template for SLV/FVA labels or eliminate the need for labels for SLV/FVA. Scheduling among schools carrying out combined clinics needs to avoid lunch times so students having FVA can wait the required 30 minutes before eating and drinking. For the clinical team, a minimum of 3 nurses will be required to carry out SLV and FVA simultaneously and maintain clinic flow. Additionally, there needs to be a referral or follow-up source for some students from nurses. Other health department considerations include creating a mass encounter FVA code for students that do not get billed and possibly billing private insurance for students that are not recipients of TennCare.

Coordinated School Health was an asset in the success of this pilot program.

Anyone interested in learning more details about carrying out SLV/FVA clinics through their health department can contact Washington County Health Department Director Christen Minnick at 423-975-2200 or Christen.Minnick@tn.gov.