Improving Influenza Vaccination Rates in Hospitalized Asthmatics: A Three-year Longitudinal Quality Improvement Initiative
Objective: Annual influenza (flu) immunization is recommended for all children with asthma, and the inpatient setting represents a prime opportunity for immunizing patients. Prior to project initiation, the average influenza immunization rate in children admitted with asthma exacerbation at our institution was 13%. Our aim was to increase the influenza immunization rate of eligible PHM asthma patients to 80% during the 2015-2016 flu season. Design/Methods: This is an ongoing three year QI project, with interventions in previous years including 1. Electronic Medical Record (EMR) support: enhanced documentation of immunization status and ease of ordering immunization 2. Family engagement: provided flu vaccine information sheets and posters in family areas 3. Provider education and awareness The main interventions this year were creation of a Best Practice Alert (BPA) in the Epic EMR and implementation of a nursing-driven protocol for flu vaccine administration. Extensive education was provided to nursing and pharmacy staff regarding the new protocol. Measures included: Outcome: flu immunization rate, Process: correct firing of flu BPA, Balance: adverse immunization reaction Results: After serial PDSA cycles, influenza immunization rate was successfully increased to 41% in 2013-2014 and 67% during 2014-2015. Data analysis for immunization rates this year is ongoing, and will be completed by October 2016. Discussion/Conclusions: BPAs are an effective tool in improving care by prompting providers about recommended therapies, which eliminates a component of human error. Resident perception surveys conducted during our study identified forgetting to ask about vaccine status or order the vaccine as barriers to providing immunizations. Additionally, several misconceptions that were prevalent in our institution, such as the need for physician documentation of parental consent for immunization and believing that immunization could only be given upon discharge, were addressed. A major component of successful implementation of our BPA and nursing-driven immunization protocol was obtaining buy-in from hospital leaders and working via a multi-disciplinary team in creation of an effective workflow and disseminating information to providers.
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