Date of Award

Summer 2023

Project Type

Thesis

College or School

CHHS

Department

Nursing

Degree Name

Master of Science

First Advisor

Kaitlynn Liset

Second Advisor

Pamela Kallmerten

Abstract

BACKGROUND: Adherence to the standardized childhood immunization schedule put forth by the American Academy of Pediatrics is the gold standard for decreasing vaccine-preventable disease morbidity. The first step to improving adherence with the recommended immunization schedule is identifying children who are under-immunized. The inpatient setting offers an opportunity to screen pediatric patients for immunization status. A survey was administered to nurses working on an inpatient pediatric unit to gauge nurse self-report of Cerner™ Electronic Health Record (EHR) use for immunization documentation, their perceptions regarding EHR ease of use for documenting pediatric immunization status, attitudes towards documenting immunization status, and perceived implications for nursing care.

METHODS: The Define, Measure, Analyze, Implement, Control (DMAIC) framework was utilized for this quality improvement project. The pre-intervention survey was administered anonymously to six nurses working on the unit. The results revealed a discrepancy between self-reported assessment practices and self-reported documentation practices concerning patient immunization status. Based on these findings, the intervention was implemented. A post-survey was conducted to re-examine nurse documentation practices and attitudes towards the change.

INTERVENTION: Based on current evidence supporting the importance of nurse-driven screening in identifying patients at risk for vaccine-preventable diseases and the survey results revealing that some pediatric unit nurses do not always document childhood immunization status upon admission, the decision was made to change the previously optional question regarding immunization status in the EHR’s Admission History PowerForm™ to a required field. The quality improvement intervention was implemented in collaboration with pediatric unit leadership and the facility’s Nursing Informatics Committee. A Situation, Background, Assessment, Recommendation (SBAR) report was disseminated to substantiate the change.

RESULTS: Missing data from the post-survey limited the evaluation of nurse documentation practices and attitudes towards the newly required EHR field following the intervention. There was one respondent to the post-survey, who reported documenting immunization status during admission 100% of the time and provided qualitative feedback supporting the change. Unit leadership reported that the change was accepted by staff.

CONCLUSIONS: This quality improvement project was a useful first step towards improving nurse-driven screening practices in the pediatric unit. Identification of patients at risk for vaccine-preventable disease is the foundation required to increase immunization rates on a population health level. However, to sustain and progress towards improving immunization status screening and ultimately increasing opportunities for children to be brought up to date on vaccinations, further steps will be required on behalf of unit leadership and staff. Those steps should include chart audits to monitor compliance with required EHR fields, the development of a written policy for immunization documentation, and efforts to increase the availability and administration frequency of vaccines for under-immunized children admitted to the unit.

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