EP12 - Nurses assume leadership roles in collaborative interprofessional activities to improve the quality of care.

Provide one example, with supporting evidence, of a nurse-led (or co-led) collaborative interprofessional quality improvement activity.

The incidence of pertussis, also known as Whooping Cough, has dramatically increased in New York State. This disease is often unrecognized in adults, but in infants it is extremely serious and often fatal. In 2013, the New York State Department of Health instituted a regulation that requires healthcare organizations delivering babies to offer Tetanus, Diphtheria, and Pertussis (TDaP) vaccination to family members and caregivers of infants prior to the discharge of the infant. The mechanism for addressing this new regulation was not specified. To receive services a person needs to be registered in the organization's electronic system as either an outpatient or an inpatient. In the instance of a caregiver or family member other than the mother and baby this posed a challenge. Implementing this program involved associates from Finance, Reimbursement, Registration, and Nursing, Pharmacy, and Health Information Management, as well as medical providers.

The Perinatal Safety Nurse, Beth Wilcox, RN, undertook the development and implementation of the program. In August of 2013, she invited a group of hospital representatives from medical records, pharmacy, registration, finance, Department of Obstetrics nurses and information management to discuss the implementation of TDaP vaccination for families and caregivers of newborns.
At the initial meeting, the following action items were identified and assigned:

Perinatal Safety Nurse:

• Develop the Screening Tool to identify eligible candidates for vaccination
• Compose a letter to families introducing the program, with instructions for the screening tool
• Locate Informational pamphlet regarding pertussis and TDaP
• Order Immunization record cards from the NYSDOH for providing information to the caregiver's primary care provider
• Create folders containing all of the necessary information, to distribute during labor
• Develop procedure for nursing to access vaccine and administer
• As point person, communicate with the team to facilitate the entire process

Patient Registration:

• Develop procedure to register caregivers as outpatients and place them in OB outpatient bed
  temporarily so as vaccination could be given. Caregiver would take completed screening form to registration, it then would be faxed by registration to the pharmacy.  

Pharmacy:

• Develop procedure to provide access to vaccine in PYXIS
• Identify pharmacy cost of vaccination for the recipient.

Medical Records:

• Medical Records Committee to approve immunization screening form.
• Copy of screening form to be scanned into electronic medical record

Nursing Informatics:

• Create documentation box in Obstetrics Maternal Admission, indicating Caregiver T-Dap Packet given.

Finance:

• Create procedure for processing the immunization cost to caregiver's insurance carrier/ self pay, if patient’s policy does not cover.

Registration:

• Create a process to register caregivers as outpatients in Obstetrics to create a "visit", which generates a medical record and allows entry of person into PYXIS to access the vaccine.

Medical Staff:

• Notification to the hospital's Medical Director of the standing order that can be initiated through the NYSDOH Public Health Law 2805-h. Vaccination can be offered and provided, if requested, to parents and anticipated caregivers of all newborns being treated in hospital after their birth.
• Notification to the obstetrical providers that this new procedure was being implemented. Literature was also sent to the offices to encourage vaccination during pregnancy so that immunity is mature when the baby is born.
• The new process was initiated in September, 2013. With a few snags, the process was refined and proceeded without difficulty. The first dose for family/caregiver was given in November, 2013. Through July of 2014 the staff have administered between one and four doses per month. Of note, the obstetrical provider offices have been actively encouraging caregiver vaccination during pregnancy so many candidates have already received TDaP before the infant is born.

Exhibit EP12.1, IAC screening checklist

Exhibit EP12.2, Cocooning 

Exhibit EP12.3,  TDaP VIS

Exhibit EP12.4 Excerpt from McKesson Paragon Clinical Care Station Daily Focus Assessment