Implementation of a Quality Improvement Influenza Immunization Project in a Convenience Care Clinic
Advisor:Graham, Margaret Clark
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
NATURE AND SCOPE OF PROJECT: The Centers for Disease Control and Prevention (CDC) estimates that influenza vaccination prevented approximately 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths in the United States during the 2017-2018 influenza season (CDC, 2019). The Advisory Committee on Immunization Practices (2018) recommends influenza vaccination as a primary prevention measure against infection in all individuals six months and older who do not have contraindications. The objectives of this quality improvement project were to (a) address common barriers to influenza vaccination; (b) develop a standardized process for influenza vaccination delivery at a Convenience Care Clinic (CCC); (c) evaluate the impact of this process change on the CCC’s influenza vaccination rates. PROJECT IMPLEMENTATION: An educational quality improvement project was guided by Lewin’s Change Model and Rosswurm and Larrabee’s Model for Evidence-Based Practice Change. The 4 Pillars™ Practice Transformation Program is an evidence-based educational and support program developed by the University of Pittsburgh and funded by the CDC to increase immunization rates (4 Pillars™, 2019), and this served as a model for project implementation. METHODS: Data collection in October 2018 included the number of patients that presented for an acute illness at the CCC compared to the number of patients that presented for an acute illness that were vaccinated for influenza at that encounter. This was compared to retrospective data from October 2017. Patient age and gender, as well as vaccinations ordered per health care provider (HCP), were measured to evaluate for trends. HCPs tracked reasons the vaccine was not administered or offered. OUTCOMES: The proportion of patients presenting for acute illness management at the CCC that received an influenza vaccine at that encounter was 2.5% in 2017 and 33.9% in 2018 during the observed time period. This was found to be statistically significant with an estimated 31.4% increase from 2017 to 2018 in vaccinating patients against influenza when presenting for acute illness management. Patient age and gender were not found to impact vaccination rates. Most HCPs demonstrated statistically significant improvements in vaccinating against influenza from 2017 to 2018. “Personal choice” was the most frequent reason that vaccine eligible patients declined immunization. RECOMMENDATIONS: Recommendations include developing a standardized process for offering influenza vaccination to all eligible patients and understanding the common missed opportunities and barriers to influenza vaccination so that this may be used to inform future educational efforts.
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