• Improving Influenza Vaccination Rates in Inpatient Pediatrics

      Hoffer, Amy; McComiskey, Carmel A. (2021-05)
      Problem: This quality improvement project was implemented on an inpatient pediatric unit at an urban academic medical center whose rate of influenza vaccination prior to discharge was only 39% of eligible patients. This gap in vaccination is not unique to this unit and morbidity and mortality of influenza is high despite widespread availability of a vaccine and the recommendation that all children over six months of age receive the vaccine. Purpose: The purpose of this project was to increase vaccination rates by providing education and rescreening prior to discharge. Methods. The electronic health record (EHR) was modified to populate a prompt to the nursing task list for every patient who initially refuse the flu vaccine. Bedside nurses then provided education to all patients and parents who refused. They documented this education and asked the parents if they would reconsider vaccinating prior to discharge. The outcome measures of this project included improving EHR nursing documentation of education and rescreening and increasing vaccination rates prior to discharge. Results: Of patients whose caregiver refused the flu vaccine on admission, 61% received the intervention and 27% of these caregivers reconsidered and decided to vaccinate. The vaccination rate of eligible patients prior to discharge for this unit increased from 39% to 60%. Conclusion: Optimizing the use of the EHR to automatically remind nurses to provide education and additional vaccination opportunity can increase vaccination rates. This unit’s improvement in vaccination rates and the number of caregivers who received the intervention and subsequently agreed to vaccinate demonstrates that this is a valuable tool if there is otherwise no process in place to prioritize vaccination. This intervention can be easily modified to be used in other patient populations and for other vaccinations.
    • Increasing Human Papillomavirus Vaccination Rates Among Adolescents in Primary Care

      Hodge, Rachel E.; Hoffman, Ann G. (2020-05)
      Problem and Purpose: Each year, 33,700 men and women in the United States are diagnosed with a cancer caused by infection from the human papillomavirus (HPV), 90% of which could have been prevented through vaccination. Despite the proven safety and effectiveness of this vaccine, rates of uptake are low nationwide, a mere 53.7% for females and 48.7% for males. The purpose of this quality improvement (QI) project was to implement and evaluate interventions guided by the 4 Pillars™ for Practice Transformation Program, an evidence-based tool-kit shown to increase HPV vaccination rates across settings, including in primary care. Methods: A bundle of interventions was implemented using the 4 Pillars Program. Pillar 1 Convenience and Easy Access: all patient encounters of those aged 11-18 were used as an opportunity to vaccinate (not just well visits). Pillar 2 Patient Communication: providers issued a “strong recommendation” for the HPV vaccine using the Same-Way Same-Day strategy from the Centers for Disease Control and Prevention (CDC). Pillar 3 Enhanced Vaccination Systems: Immunization status was assessed as part of vital signs and Vaccine Information Statements (VIS) were given to all eligible patients’ parents. Pillar 4 Motivation: progress toward improving HPV vaccination rates was tracked and posted in staff break room. Results: Implementation of this tool-kit resulted in an increase in the HPV vaccination rate from 68% to 76.6%, an 8.6% increase (p<0.01). 100% of patients presenting for 11-year-old well child checks were vaccinated (n=32). 100% of eligible patients were given VIS and immunization status was assessed as part of vital signs for 100% of patient encounters. There was no real gender difference discovered in the final HPV vaccination rate. Among males (n=521), there was a 78% final rate and 76% for females (n=574), echoing the closing of the gender gap nationwide. 15 patients who previously refused, consented and were vaccinated. Conclusion: This QI project demonstrated this vaccination tool-kit is an effective way to increase HPV vaccination among adolescents in primary care.