In December 2010, the U.S. Department of Health and Human Services launched Healthy People 2020, a 10-year agenda for improving health for all Americans. The program tracks 1,200 objectives in 42 topic areas, one of which is to increase immunization rates in order to reduce vaccine-preventable diseases.
The Kelsey Seybold Clinic, of Houston, Texas, wanted to create a strategy that would boost the immunization rates of their patient population, which reached 340,260 in 2015 across 23 clinic locations. Using the Healthy People 2020 initiative as an external benchmark for pneumococcal pneumonia, herpes zoster and influenza vaccination rates, the Kelsey Seybold Clinic realized they performed below average in 2014 and 2015, also struggling to meet internal benchmarks set by the clinic.
After implementing a new strategy in 2015, the clinic met and surpassed their goals for herpes zoster and pneumococcal pneumonia. The planning stage to improve immunization rates consisted of three parts: create an Immunization Committee, evaluate standing orders and identify patient needs.
- Create an Immunization Committee
The clinic established an Immunization Committee to oversee all branches with involving the health care team with administering vaccines, instead of just the primary care physician, as was the routine since the clinic’s inception. A nursing supervisor, multispecialty nursing staff, clinical education staff and quality improvement staff comprised the teams at each clinic. To lead the Immunization Committee, a physician champion, Melanie Mouzoon, MD, FAAP, managing physician for immunization practices, was appointed based on her genuine interest in improving immunization rates. Jacqueline Evans, MBA, LVN, supervisor of quality improvement, describes that Dr. Mouzoon was “chosen because she is a passionate pediatrician/hospitalist who has demonstrated a genuine interest in improving immunization coverage of our patients, thus reducing the incident of vaccine-preventable diseases.”
- Evaluate Standing Orders
The Kelsey Seybold Clinic has used standing orders for many years to improve the workflow for their immunization nurses. However, the clinic wanted to authorize licensed vocational nurses, registered nurses and certain medical assistants to implement standing orders and begin administering more vaccinations. “We found standing orders to be such a powerful tool that we empowered all nurses to order and give immunizations from standing orders,” said Evans.
- Identify Patient Needs
The Kelsey Seybold Clinic partnered with the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) Immunizations Network, which is designed to provide education, technical assistance and provider sharing to facilities across Arkansas, Missouri, Puerto Rico and Texas. Through its network membership, the clinic gained access to educational webinars and tools, one of which was especially valuable—the Centers for Disease Control and Prevention’s Patient Intake Form. By using this form, patients are encouraged to participate in their health care by recognizing which vaccines fit their lifestyle.
Before putting their plan into action, clinic leadership revealed one final aspect of the intervention. They would take administering vaccinations one step further and hold a competition to reward members of the nursing staff who administer the most vaccinations at the time of the patient visit. On a monthly basis, the clinic awards a plaque to the staff member with the most injections to keep at his or her work station, with the second and third place winners receiving customized ribbons.
Then it was time for the clinic to implement its immunization strategy. When a patient presents to the clinic for an office visit, Kelsey Seybold Clinic’s electronic health record, Epic, fires Best Practice Alerts to notify the staff of any timely vaccinations. The nurse will then retrieve a Vaccine Information Sheet to prepare the patient for the vaccine. When the patient gives consent on a permission form, the nurse administers the vaccine, many times before the provider even enters the room.
Best Practice Alerts will fire until the immunization order is accepted or declined. The clinic takes special care with patients who decline immunizations. Kelsey Seybold Clinic’s intranet has a multitude of information sheets available for providers or nursing staff to choose from to help keep patients informed of the scientific research behind vaccines, as well as debunk any false beliefs.
Through this intervention, the Kelsey Seybold Clinic has been able to meet or exceed herpes zoster and pneumococcal pneumonia external benchmarks (Healthy People 2020). However, the clinic is far from finished. The clinic sees many opportunities in the future to achieve even higher immunization rates through outreach letters, follow-up calls and advanced scheduling for vaccines.
Furthermore, the Kelsey Seybold Clinic will focus on boosting their influenza vaccination rates to meet the set benchmarks as the 2016-2017 flu season approaches.
The clinic believes that within a large health care organization, a physician champion is as vital to successful change as the quality improvement team. However, the key to their success might be attributed to friendly competition. Evans believes that “most people want to do good, but sometimes it takes something to spark their competitive spirit.”
For more information about the Kelsey Seybold Clinic, please contact Jackie Evans, Jackie.Williams@kelsey-seybold.com.
For more information about the TMF QIN-QIO Immunizations Learning and Action Network, please visit TMFQIN.org, or email firstname.lastname@example.org.
This material was developed by TMF Health Quality Institute, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. This content does not necessarily reflect CMS policy. 11SOW-QINQIO-F1-16-22