1. Johann, Deborah RN, MSN
  2. Shapourian, Barbara RN
  3. Budd, Kent BS

Article Content

Background: Pneumococcal vaccination, a state core measure, has shown efficacy of 56% to 81% in protecting against pneumococcal infection. However, despite this compelling motivation, our hospital had poor and variable results until the process was redesigned. Our redesign has given us a shot of success, with the current rate bordering on the state benchmark of 63%.


Over the past 2 years, our compliance rate has ranged from 4% to 45%. Success has been dependent on the vigilance of the staff in monitoring and encouraging physicians to address vaccine status. Neon stickers and notes have been used to cue them. Historically, the compliance rate has always been viewed, but there were no tools to monitor or modify compliance concurrently.


Process Redesign: In August 2006, the process was redesigned completely to be dependent on nurses' assessment and order initiation. The patient's risk factor assessment was incorporated into the initial online assessment, and the questions were mandatory. Currently, appropriate risk factors initiate a care plan that prompts further follow-up assessment. Once the care plan is completed and the vaccine date of administration is entered, these data are recalled at the next admission. Without availability of an electronic medication record, creation of a care plan that addressed this was a novel approach to recalling the data.


Perhaps the most valuable part of the redesign was the development of a report that provides current salient data. This report allows unit managers to pinpoint patients at risk, those who have their care plan activated, and those who have the pneumococcal vaccine in the pharmacy profile. If any of these indicators do not all display "yes," the manager can pinpoint who is at risk and whether a piece of the process has not been fully deployed. This enables management to be proactive in addressing this initiative. Managers have found this extremely valuable.


Impact: Since the redesigning, we have been on a steady upward trend of success. At this writing, we are achieving a rate of 63%, the highest for our hospital to date. Process redesign and the use of tools to monitor or modify compliance have given us a true shot at success.