Increasing the Pneumococcal

and Influenza vaccination

hospitalized patients

Dr. Robyn PoteetDr. Amruta Parekh

University of Texas Health Science Center at San Antonio San Antonio, TX

Educating for Quality Improvement & Patient Safety

Robyn Poteet, M.D.

(210) 358-1944

poteetr@uthscsa.edu

Educating for Quality Improvement & Patient Safety

CONTACT

TEAM

Educating for Quality Improvement & Patient Safety

• PHYSICIANSHospital Medicine – Robyn Poteet

• FACILITATOR

Amruta Parekh, MD, MPH

• NURSING

• PHARMACY

• SOCIAL WORK

•TECH/STATISTICAL SUPPORT

Wayne Fischer, MS, PhD

Need team picture

Please fill in the names…

LIST OF CUSTOMERS

Educating for Quality Improvement & Patient Safety

• PATIENTS

• PROVIDERS

• NURSING

•PHARMACY

• HOSPITAL ADMINISTRATION

BACKGROUND

Educating for Quality Improvement & Patient Safety

• Literature….Please fill in

some literature

justifying the

aim statement

AIM STATEMENT

Educating for Quality Improvement & Patient Safety

To increase the rate of

Pneumococcal and Influenza

vaccination by 20% over a period

of 4 months in patients

hospitalized with Pneumonia

Preintervention data for

Influenza Vaccine

CL 0.101

UCL0.366

0.000

0.100

0.200

0.300

0.400

0.500

0.600

2007 Jan 2007 Feb 2007 Oct 2007 Nov 2007 Dec 2008 Jan 2008 Feb

Fra

cti

on

giv

en

vaccin

e

Months (given only during the "Flu" season)

LCL 0.0

Only 10% of eligible patients were receiving the vaccine on discharge !

Preintervention data for

Pneumococcal Vaccine

Only 30% of eligible patients were receiving the vaccine on discharge !

There was a lot of variation too.

CL0.300

UCL0.861

0.000

0.200

0.400

0.600

0.800

1.000

1.200

2007 Jan

2007 Feb

2007 Mar

2007 Apr

2007 May

2007 June

2007 July

2007 Aug

2007 Sept

2007 Oct

2007 Nov

2007 Dec

2008 Jan

2008 Feb

2008 Mar

2008 April

2008 May

2008 June

2008 July

2008 Aug

2008 Sept

Perc

en

tag

e g

iven

vaccin

e

Months

LCL 0.00

PROCESS FLOW - Pre Intervention

CAUSE & EFFECT DIAGRAM

Intervention• Team discussed the process

• Found out:

• Too cumbersome

• Missed some of the patients due to lack of

immunization records on charts

• Delay in getting vials form Pharmacy led to

delayed discharge or even patient refusal

• Action taken

• Have immunization data on electronic medical

record (EMR) on admission.

• Have vaccine vials on patient floors

PROCESS FLOW - Post Intervention

CL 0.101

0.771

UCL

0.353

1.000

LCL

0.422

0.000

0.200

0.400

0.600

0.800

1.000

1.200

2007 Jan 2007 Feb 2007 Oct 2007 Nov2007 Dec2008 Jan 2008 Feb 2008 Oct 2008 Nov2008 Dec2009 Jan 2009 Feb2009 Mar

Fra

cti

on

of

pati

en

ts g

iven

vaccin

e

Months

Preintervention PostinterventionPreintervention Postintervention

0.0

UCL

CL

LCL

Preintervention Postintervention

0.0

UCL

CL

LCL

Preintervention Postintervention

0.0

UCL

CL

LCL

Preintervention Postintervention

0.0

UCL

CL

LCL

Comparison of Pre and Post intervention

Influenza Vaccination in patients

Comparison of Pre and Post intervention

Pneumonia Vaccination in patients

CL 0.300

0.645

UCL

0.861

1.000

0.000

0.200

0.400

0.600

0.800

1.000

1.200

Perc

en

tag

e o

f p

ati

en

ts v

accin

ate

d

Months

Preintervention Post intervention

RESULTS

Educating for Quality Improvement & Patient Safety

•Influenza vaccination: Increased number of

immunized patients from 10% to 70%

•Pneumococcal vaccination: Increased

number of immunized patients from 30% to

64.5%

•More streamlined process

•Faster ..as vaccine available on floor

•Less duplication of work as EMR captured

data

RETURN ON INVESTMENT

Educating for Quality Improvement & Patient Safety

We put in… We hope to achieve…

•Cost of vaccine on floor

•Start-up cost = $•could include storage??

•Yearly cost = $

•Approx ?? medicine

admissions/month

•Average ?? Get vaccinated per

month

•$ generated

WHERE ARE WE GOING?

Educating for Quality Improvement & Patient Safety

Other possible interventions:

Educating for Quality Improvement & Patient Safety

PERTINENT POINTS FROM

LITERATURE

CONCLUSIONS

Educating for Quality Improvement & Patient Safety

•Baseline process was extremely complicated and

involved lot of steps.

•Critical evaluation of the process enabled us to identify

simple solutions that made a big difference.

•Seeing the variability in the SPC chart before and after

intervention showed surprising but reassuring results.

•Knowledge of basic tools was integral to visualizing

the goal and achieving the aims.

Educating for Quality Improvement & Patient Safety

QUESTIONS?

Educating for Quality Improvement & Patient Safety