Keep Patients Safe - Vaccinate

Purpose:
A multi-disciplinary team was formed to evaluate the hospital's compliance with the assessment, administration, and documentation of patient's influenza and pneumococcal vaccines. The goal of the team was to utilize technology to provide the nurses the confidence needed to safely vaccinate.

Significance:
Vaccines have been shown to be the best prevention for many infections. Through assessing and administering vaccines during hospitalization, patients that are at risk can be vaccinated. Also, vaccine data is reported publicly through Centers for Medicare and Medicaid Services.

Strategy and Implementation:
There was a process for inpatient vaccines; however it was cumbersome. The inpatient vaccine team reviewed the literature and evaluated the nursing process. Feedback was gathered and highlighted multiple barriers. Two root causes were prioritized. First, the criteria in the nursing protocol was vague and confusing, causing nurses to perceive potential for patient harm. Also, the process was complex and not aligned with workflow. The changes included revising the electronic form to create a “smart” process. Conditional logic was imbedded as a guide for the nurse. This logic was enhanced by the option to answer “unknown” with clear actions. The nurses selected the order of the questions to make the forms most efficient. Also timing of the vaccines were incorporated into the workflow. The nurses received education related to the new forms, process, and the significance of vaccines in patient safety. Leadership support provided for the culture change that occurred with the redesign.

Evaluation:
Using a sample of pneumonia patients,the influenza vaccine compliance improved from an average of 85% to 100% for 3 straight months. Similarly, the pneumococcal vaccine compliance improved from 89% to 100%. The global measure data for both vaccines started positive, and has been maintained.

Implications for Practice:
Other electronic forms have been re-evaluated based on the success of the vaccine project. While the data shows improvement, the nurses' ability to confidently approach vaccines through the use of technology, serves as the greatest accomplishment.