AIM: 
To improve the pneumococcal vaccination initiation rates in patients 65 years and older in Jefferson Hospital Ambulatory Practice (JHAP) to the institutional quality measure goal of 80% over a 4 month period from January to May of 2017.https://jdc.jefferson.edu/patientsafetyposters/1031/thumbnail.jp

Enriquez, MD, Matthew

Kramer, MD, Daniel

Laothamatas, MD, Kemarut

Yan, MD, Linda

English

AIM: 
To improve the pneumococcal vaccination initiation rates in patients 65 years and older in Jefferson Hospital Ambulatory Practice (JHAP) to the institutional quality measure goal of 80% over a 4 month period from January to May of 2017.http://jdc.jefferson.edu/patientsafetyposters/1031/thumbnail.jp

Name not available

Improving Pneumococcal Vaccination Rates in Jefferson Hospital Ambulatory Practice Patients

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety5-31-2017Improving Pneumococcal Vaccination Rates inJefferson Hospital Ambulatory Practice PatientsKemarut Laothamatas, MDThomas Jefferson University Hospital, Kemarut.Laothamatas@jefferson.eduLinda Yan, MDThomas Jefferson University Hospital, linda.yan@jefferson.eduDaniel Kramer, MDThomas Jefferson University Hospital, daniel.kramer@jefferson.eduMatthew Enriquez, MDThomas Jefferson University Hospital, matthew.enriquez@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationLaothamatas, MD, Kemarut; Yan, MD, Linda; Kramer, MD, Daniel; and Enriquez, MD, Matthew, "Improving PneumococcalVaccination Rates in Jefferson Hospital Ambulatory Practice Patients" (2017). House Staff Quality Improvement and Patient SafetyPosters. Poster 27.http://jdc.jefferson.edu/patientsafetyposters/27BACKGROUND • Pneumococcal polysaccharide vaccines are effective against invasive pneumococcal infections which remain an important source of morbidity and mortality in older adults.  • Beginning in 2014, the US advisory Committee on Immunization Practices (ACIP) recommended PCV 13 for all adults 65 years and older.  • While superiority of the newer conjugate vaccines over the polysaccharide vaccines remains to be seen, rates of adverse events with the PCV 13 are low. • At JHAP, the pneumococcal vaccination rates for patients 65 years and older are 58% in August 2016.  • Multi-strategic approach and nurse-initiated protocols have been shown to result in higher vaccination rates without resulting in inappropriate or unnecessary vaccines. 1,2  AIM To improve the pneumococcal vaccination initiation rates in patients 65 years and older in Jefferson Hospital Ambulatory Practice (JHAP) to the institutional quality measure goal of 80% over a 4 month period from January to May of 2017.  INTERVENTION • Participants: JHAP patients, residents and MAs • Multi-strategic approach implemented over a 3 month period • Resident and medical assistant education on indications for pneumococcal vaccination and documentation • Patient education: posters and flyers promoting pneumococcal vaccination in patients 65 years and older displayed throughout our waiting area and patient rooms • Medical assistant (MA)-driven vaccination ordering protocol: one page questionnaire prompting the MAs to obtain consent and administer the pneumococcal vaccine to eligible patients through standing orders without requiring physician’s approval.  • Design: Electronic health record chart review    RESULTS • Intervention period overlapping with transition to new EMR system which integrates previous inpatient vaccinations unaccounted for in the old EMR, possibly confounding the effects of our intervention • Incomplete resident adherence to documentation of vaccine refusals • Length of follow-up may be insufficient to detect the long-term effect of the intervention   DISCUSSION Improving Pneumococcal Vaccination Rates in Jefferson Hospital Ambulatory Practice Patients Kemarut Laothamatas MD, Linda Yan MD, Daniel Kramer MD, Matthew Enriquez MD, Albert Lee MD Department of Medicine, Sidney Kimmel Medical School, Thomas Jefferson University, Philadelphia PA NEXT STEPS Fig. 2: MA questionnaire as part of the MA-driven pneumococcal vaccination protocol Fig.1: Process map of MA-driven pneumococcal vaccination initiation protocol LIMITATIONS • Administer a follow up survey to eligible patients who refused the vaccination to investigate the reasons behind the refusal. This information could be used to further augment the current approach.  • Schedule a vaccination specific clinic visit/ drop in hours • Refresher course and reminders of the current MA-driven vaccination protocol for both the residents and MA’s  • Investigate ways to improve documentation rates  of vaccine refusals and  past vaccinations by both the MA’s and the residents  Fig. 3: Weekly percentage of patients who presented to JHAP age ≥ 65 who have received pneumococcal vaccination 0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%July 2015 - June 2016 August 2015 - July2016September 2015 -August 2016March 2016 - March2017April 2016 - April 2017Date Percentage of vaccination Fig. 4: Percentage of all patients in JHAP age ≥ 65 who have received pneumococcal vaccination Time period Percentage of vaccination Intervention Fig. 5: Patients in JHAP age ≥ 65 who refused pneumococcal vaccination • After the intervention was implemented, there was an improvement in the percentage of patients 65 years and older who presented to JHAP and received pneumococcal vaccination. • There was a sustained increase in pneumococcal vaccination during the intervention period. • There continued to be a large number of patients who refused pneumococcal vaccination despite the change in patient education via posters/flyers and physician discussion with patients advocating for vaccination. • The reason for patient refusal of pneumococcal vaccination was not an aim of this project and was not thoroughly addressed during this intervention.  REFERENCES 40.00%50.00%60.00%70.00%80.00%90.00%100.00%11/28/16-12/2/1612/5/16-12/9/1612/12/16-12/16/1612/19/16-12/23/1612/26/16-12/30/161/3/17 -1/6/171/9/17 -1/13/171/17/17-1/20/171/23/17-1/26/171/30/17- 2/3/172/6/17 -2/10/172/13/17-2/17/172/20/17-2/24/172/27/17- 3/3/173/6/17 -3/10/173/13/17-3/17/173/20/17-3/24/173/27/17-3/31/174/3/17 -4/7/174/10/17-4/14/174/17/17-4/21/174/24/17-4/28/175/1/17 -5/5/17Pre-Intervention Median Percentage Post-Intervention Median Percentage Start of Intervention Patients with undocumented refusal reasonPatients who refused because they needed more time tothinkPatients who refused because they deferred to later visit1. Rhew DC, Glassman PA, Goetz MB. Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders. Journal of General Internal Medicine 1999;14:351-6 2. Centers for Disease Control and Prevention. Use of Standing Orders Programs to Increase Adult Vaccination Rates: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000/ 49(RR01); 15-26  

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Improving Pneumococcal Vaccination Rates in Jefferson Hospital Ambulatory Practice Patients

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