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