Upload
jeffery-houston
View
220
Download
3
Embed Size (px)
Citation preview
13 by 213 by 2Pediatric ImmunizationsPediatric Immunizations
Eban Experience Session II
June 17, 2011
AimAim
• Goal – Increase the 2 year old immunization up-to-date rate for East African children who receive care at Brooklyn Center or Riverside Clinics.
• Aim – Decrease the number of African American or Black children who are 18-23 months of age and not up-to-date with immunizations to <2/clinic.
Project TeamProject Team
Nora Ali, community memberSaid Ali, interpreter, Riverside ClinicSurra Benti, community memberSandi Broberg, RN, Brooklyn Center ClinicDave Griffin, MD, Woodbury ClinicJudy Jerde, nursing project coordinatorDeb Johnson, MD, Riverside ClinicJen Pfeiffer, LPN, Riverside ClinicDana Langness, quality coordinator
Workflow – Workflow – as isas is
Immunizations in Epic
Immunizations Due
Review immunization history, Health Maintenance
& immunization schedule
Immunizations in MIIC
Enter history in Epic
If child is school age, contact school for
immunization record. If not school age or school
unknown or no record, contact parent re:
immunization record
YesNo
Yes
No
“Yes” in Previsit Health Maintenance, note specific
immunizations
A
B
AppointmentAge 0-23 months
Immunizations record obtained
Yes
If no records available, treat as unimmunized
MIIC previously checked for
history
Yes
No
Immunizations in MIIC
No
Yes
YesNo
Previsit Planning
No
Workflow – as Workflow – as isis
B A
Rooming, Chief Complaint note Immunizations UTD
Rooming. Inform parent of immunizations due. Give
VIS. Chief Complaint note Immunizations
Parent agrees to immunize
Rooming person orders or pends orders
Note in Chief Complaint No
Yes
Rooming
C D
Workflow – as Workflow – as isis
Provider discusses, reinforces importance
Provider discusses concerns/reason for declining with parent
OK to administer
today
Administer today
If too ill or parent declines due to illness, ask to schedule nurse visit in
1-2 wks
*If Well child visit, next anticipated immunizations are on After Visit Summary
Administer at future time
Document in chart. Imm/Injection “deferred”, Health
Maintenance “exclude”
Document in chart. Instruct parent re: scheduling appointment
Administer. Give updated record. Inform parent of when
next due*
No
Yes
No
No
Yes
Yes
Provider Visit
Rooming Person
DC
PDSA # – 2
Objective Administer immunizations to African American or Black children who are 3-23 months and seen for an illness visit or are ill at the time of a well child visit who have immunizations that are due or overdue.
Predictions HPMG employed interpreters, rooming and provider staff will consistently recommend immunizations when there is not a medical contraindication or will ask the parent to schedule a nurse appointment if the vaccines are not administered at the visit. Some parents will have their child immunized at the time of the visit. Some parents will return later for a nurse appointment to have their child receive needed immunizations.
Population African American or Black children who are 3-23 months and seen at Brooklyn Center or Riverside for an illness visit or are ill at the time of a well child visit who have immunizations that are due or overdue.
Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:
Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:
PDSA # - 2TEST CYCLE 1 Start Date: 5/20/11 End Date: 6/9/11
Plan Staff education: review illness immunization contraindications with clinic staff to answer questions, assure consistent messaging to parents and knowledge of this intervention.Ill visit process: identify children who need immunizations, inform parent and provide information, provider discusses with parent, if parent declines, “nurse referral” to return in 1-2 wks.
Do Brooklyn Center – 10 patients, 1 received immunizations, 1 returned, 1 with contraindication, 5 parents declined, 2 unknownRiverside – 9 patients, 4 received immunizations, 1 with contraindication, 4 parents declined
Study Collect data re: how many parents bring child back for immunizations“It is OK” information sheet is a good visualEngaging and educating staff is critical – it gives parents confidence that it’s OK to immunize
Act Further reinforcement with staffBetter utilization of “It is OK” information sheetSpread learnings
IT IS OK TO RECEIVE SHOTS IF YOU HAVE ANY OF THE FOLLOWING
FEVER LESS THAN 102.0 RUNNY NOSE
SNEEZING EAR INFECTIONS ON ANTIBIOTICS
COUGH AND COLD VOMITING & POOR APPETITE
PDSA # – 3
Objective Administer immunizations to African American or Black children who are 2-23 months whose parents who have concerns about vaccine safety.
Prediction Some parents will chose to have their children receive the recommended vaccines per schedule.
Population African American or Black children who are 3-23 months and seen at Brooklyn Center or Riverside whose parents are hesitant to have their child receive immunizations.
Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:
Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:
PDSA # - 3TEST CYCLE 1 Start Date: 5/20/11 End Date: continuing
Plan Patient awareness: post “Vaccination FACTS” in exam room & provide parents with “Small Steps Can Save Small Lives”.Parent discussion: determine cause for concern, acknowledge concerns about safety as sign of good parenting, stress lives saved & illness prevented as result of immunizations, use CASE model for conversation about vaccine safety.
Do Brooklyn Center – 0 patientsRiverside – 5 patients
Study Not enough data to evaluate, expand through 5 yrs of age, continue this cycleSome children have “Delayed immunizations” on Epic Problem list, but there isn’t information about the delay in the Comments
Act Ask providers & nurses to use Problem List to communicate information about delayed immunizations
How have you integrated your How have you integrated your community advisor into your community advisor into your
improvement work?improvement work?• Attend team meetings
• Participate in meeting discussions
• Suggested ways that they can assist with the project
• “Non-community” team members have learned about East African community, including how to better partner with community to increase immunization rates
Successes & ChallengesSuccesses & Challenges
• Successes
– Three PDSA cycles
• Challenges
– Time!
– How to better utilize community members and implement interventions outside of the clinic setting