Describe one improvement in the clinical practice setting that occurred as a result of the use of internal experts. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data. OR Describe one improvement in the clinical practice setting that occurred as a result of the use of external experts. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Background In 2006, New York State adopted a program to provide Hepatitis B "birth dose" vaccinations for newborns. The goal of this program is to protect infants from transmission of Hepatitis B from caregivers between birth and their first vaccinations at the pediatricians' office. For a number of reasons this program was not well-received at FF Thompson. The physician providers felt it was unnecessary and conveyed this bias to patients and staff. By 4th Quarter of 2012, our vaccination rate was only at 50%. The New York State Department of Health (NYSDOH) provides experts who review the documentation and vaccine rates annually. At the annual visit in June, 2013 visit they expressed their frustration with the low rate of vaccination. The NYS DOH experts recommended strategies to improve vaccination rates:
Goal Increase the percentage of newborns receiving "birth dose" of Hepatitis B vaccination to 70% Participants:
Lynn Pollack, MSN, RN, Perinatal Hepatitis B Coordinator, NYSDOH Lynne Dey, BSN, RN, Program Director, NYSDOH Hospitals and Diagnostic Treatment Centers Program Ann Sullivan-Frohm, BSE, Western Director of Epidemiology, NYSDOH Deborah Jones, BSN, RNC-OB, C-EFM,PLNC, Director of Obstetrics, FF Thompson
Nursing staff were provided with a link to the Immunization Action Coalition (IAC) website, which offered an electronic slide presentation and a recorded webinar regarding vaccination. The slide presentation was also viewed at the July, 2013 staff meeting/ Skills Day. At the Skills Day the nurses were introduced to handouts from the Immunization Action Coalition for patient education. The handouts are now provided to every patient with her admission paperwork . Discussion at the staff meeting included using non-judgmental wording in presenting the vaccination procedure to parents. A question about plans for administration of the birth dose of Hepatitis Vaccine for the newborn was incorporated into the mother's Admission Record in the Electronic Health Record (see excerpt in Exhibit EP8EO.1) to facilitate discussion and review of the VIS and consent in labor. The New York State experts emphasized to the Director that in their experience the most effective method of engaging staff is to call attention to the incidence of medical errors. Many serious negative outcomes have occurred when mother's antigen test is reported as negative and the neonate is not vaccinated, when in fact the mother is positive and transmits the hepatitis to the baby. Both presentations from the IAC emphasized and illustrated incidents of medical error that resulted in transmission of the virus to newborns. A poster from the Immunization Action Coalition was laminated and posted in the Nursery and the staff break room. The hepatitis B monthly vaccination rate was added as one of the three quality measures included on the public visual management boards posted in the hallway. The graph below shows the change in vaccination rate following the staff meeting in July, 2013. The vaccination rate has outperformed the goal of 70% each quarter since the fourth quarter of 2013.
This screen shot illustrates the field for documentation of vaccination plans in the electronic Admission Assessment.
Exhibit EP8EO.1 Excerpt from the mother's electronic Admission Record
Exhibit EP8EO.2 Hep B handout.pdf
Exhibit EP8EO.3 IAC handout.pdf
Exhibit EP8EO.4 Birthdose-handout-co.pdf