Pneumococcal Immunization

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Pneumococcal Immunization

• Vernon Memorial Healthcare Viroqua, Wisconsin
• Jo Ann Von Ruden, RT, Quality Improvement
  Coordinator
• jvonruden_at_vmh.org
• (608)-637-4284
• Romelle Heisel, RN, Infection Control Nurse
• rheisel_at_vmh.org
• (608)-637-4481

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How it all started

• The initial process stemmed from staff
  participating in a series of webinars and
  workshops conducted by MetaStar in June of 2004
  through February 2005.

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Beginning Process

• When we first began reporting the pneumonia data,
  we found we rarely had documentation for any
  in-patient vaccination status.

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Initial Data

• Our first data collection for the pneumococcal
  vaccination revealed a 10 compliance rate for
  our organization!!!

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Obvious Changes are Needed

• We informed our Nursing staff and our Medical
  staff of our poor performance rates and asked for
  input on how we could improve.

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Scorecard Implementation

• We implemented scorecards in August 2004 to get
  the word out
• Power point presentations were provided
• Bulletin boards were posted at the nurses
  stations

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Collaboration

• We shared the success stories that we received
  from MetaStars training sessions with the
  Medical Staff
• We persuaded the Medical Staff to approve the
  implementation of the pneumococcal standing
  orders to hopefully improve our scores

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Who would be responsible?

• It was decided that the floor nurses would not
  have enough time to accomplish this mission
  effectively, especially during the peak, high
  volume winter months
• We felt this responsibility needed to be
  accomplished by a small core group of nurses
• A small amount of personnel would more likely
  take ownership and hold accountability for the
  results

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Selection Chosen

• October 2004 It was decided that our Infection
  Control staff would best be able to accomplish
  this goal

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Standing Order Implementation

• October 2004 Pneumococcal standing orders were
  developed and implemented

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Screening Procedure

• Screening process includes
• Verifying vaccination status with the
  patients clinic
• or NH
• - If received vaccination prior to
  admission, RN documents this date on the
  pneumococcal standing orders
• - If it appears that the patient is in
  need of the vaccination, the RN discusses the
  procedure with patient first. If the patient is
  not refusing it, the RN discusses the vaccination
  with the patients physician

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Screening Procedure Continued

• If the decision is made to not give the
  vaccination, the RN documents this reason on the
  standing order
• If the patient receives the vaccination, a
  vaccination notification is sent to the clinic
• Notification information consists of
• Vaccine given
• Date given
• Vaccine manufacturer
• Lot Number
• Who administered it

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Screening Process Continued

• We do not have an electronic record in place yet,
  so to be sure this information is passed on for
  any future admissions, a copy is made of the
  completed standing order. This copy is placed in
  a plastic folder and is placed in front of the
  patients records by Health Information
  personnel. Thus, the information travels from
  one admission to another.

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Score Timeline

• 2004
• 1st quarter 2004 10
• (initial data collection)
• 2nd quarter 2004 36
• (started to educate staff)
• 3rd quarter 2004 29
• (Additional education)
• 4th quarter 2004 81
• (implemented the standing orders)

• 2005
• 1st quarter 2005 94
• 2nd quarter 2005 100
• 3rd quarter 2005 100
• 4th quarter 2005 100

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Capturing Data During Unique Situations

• Continue to have problems verifying patients
  vaccination status on rare occasions. This
  problem occurs when
• Infection Control staff not working
• Times when the clinics are not open
• Clinic information is unavailable
• to the staff

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Help Needed

• Infection Control staff designates specific staff
  for when they are not able to be on location
  (vacation, etc.)
• We are looking into utilizing the Wisconsin
  Immunization Registry for other rare exceptions
  when information is unobtainable

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Time Consuming Process

• It is a very lengthy process that takes a team
  effort to accomplish.
• Additional staff was added to the Infection
  Control department in order to successfully reach
  our goal.

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Success! 2006 Score Timeline

• 1st quarter 2006 100
• 2nd quarter 2006 96
• 3rd quarter 2006 100
• 4th quarter 2006 results not compiled yet

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Acceptance

• This information, along with other CheckPoint
  measures, continue to be brought up at Medical
  Staff meetings, Nurses meetings, displays, board
  member meetings, etc.
• The Infection Control staff have accepted its
  purpose and have made it part of their daily
  routine

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Additional Implementation of Standing Orders

• May 2005 Medical Staff approved of
  diagnosis-specific standing orders. (These
  were under-utilized and by some physicians, not
  used at all).
• November 2006 Medical Staff approved of
  reminder check-off lists for CHF, AMI, and
  Pneumonia patients to try and capture other
  missing data

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Any Questions?