Improving pediatric influenza vaccination through a quality improvement initiative in the ED

Abstract

<p>Poster presentation</p><p>Session F presented Tuesday, October 1, 11:30 am-12:30 pm</p><p>Purpose: Influenza affects over ten million children in the United States annually and results in significant morbidity, socioeconomic burden on families, and substantial impact on healthcare services. Universal administration of the seasonal influenza vaccine is the best strategy for preventing illness and death and is recommended for all children ages six months and up, during well and sick visits, who do not have contraindications. Emergency departments offer a unique opportunity to vaccinate children that may not present otherwise for routine preventative care. Last flu season, the Emergency Department administered 56 flu vaccines. The purpose of the project was to develop an efficient, nurse-driven workflow to screen, educate, and safely administer influenza vaccines in order to increase the influenza vaccination rate in eligible children discharged from the ED. </p><p> Design: This project is an innovative quality improvement effort aimed to increase the influenza vaccination rate in eligible ED patients. </p><p>Setting: The setting of the project is pediatric emergency department/level 1 trauma center that serves over 70,000 children annually in a large metropolitan community. </p><p>Participants/Subjects: All patients who present to the ED during influenza season are screened for influenza vaccination status and evaluated for eligibility for receipt of the vaccine during their ED visit. </p>><p>Methods: A multidisciplinary workgroup performed process mapping to identify potential barriers and solutions. The electronic health record was engineered to facilitate our key interventions: a required influenza vaccination screening question, scripted patient education with supporting hand-outs, and an influenza vaccine nursing protocol with a clinical decision support tool that allowed for one-step vaccine ordering. Interventions were tested using plan-do-study-act cycles. Process measures included percent screened and percent requested. Primary outcomes were the influenza vaccination rate in unvaccinated patients requesting the vaccine. The balancing measure was ED length of stay. </p><p>Results/Outcomes: From September to December 2018, 18,829 patients presented to the ED. Influenza vaccination screening improved from 0 to 89% and 60% of children were found to be unvaccinated. 18% requested influenza vaccines and of those, vaccination rates improved from 0 to 76%. 811 vaccines were administered; a 14-fold increase over last year. Additionally, there was no change in ED length of stay. </p><p>Implications: An efficient, nurse-driven workflow that screened for vaccination status, educated parents, and then provided the influenza vaccination to children during the ED visit significantly increased the proportion of children vaccinated without extending length of stay. The combination of innovative thinking and collaborative partnerships were central to the accomplishment of the project. This is a low-cost nursing-based initiative that enhances patient outcomes and promotes optimal health and wellness of our pediatric patients and their families.</p>