Improving Immunization Data Entry Timeliness into the State Registry

Summary

Impact Statement:

The number of flu vaccines provided by Cerro Gordo County Department of Public Health (CGCDPH) has risen greatly, with many flu vaccination sites around the rural county. As the number of vaccines rose, the ability to enter the vaccines into the state immunization registry fell, and 57% of flu vaccines were not entered within 7 days of vaccination. A comprehensive QI project identified multiple causes, and multiple process changes were implemented, resulting in a rate of only 1.34% not entered within 7 days, exceeding the goal.

Summary:

CGCDPH’s Acute Infectious Disease, Epidemiology and Preparedness (AIDEP) Department administers more than 2,000 of flu, pneumococcal conjugate (PCV13), and polysaccharide (PPSV23) vaccinations during September, October, and November. Immunizations are administered by one full-time nurse at our walk-in immunization clinic and one to three nurses and support staff at more than 70 outreach flu clinics in the county. The outreach locations include senior centers and residential living facilities, schools, daycares, and businesses. Many of the outreach flu clinics are scheduled outside of normal working business hours. Other job responsibilities have to continue in addition to these services, which negatively affected staff morale and data entry timeliness into the Iowa Immunization Registry Information System (IRIS). Timely data entry of all vaccinations administered is not only a best practice, but is also important for other health care providers to know, particularly for children who need a second flu vaccine booster.

Organization that conducted the QI initiative:

CGCDPH

Citation:

Bjorklund, B. Public Health Quality Improvement Exchange. Improving Immunization Data Entry Timeliness into the State Registry. Tue, 06/26/2018 - 15:16. Available at https://phqix.org/content/improving-immunization-data-entry-timeliness-state-registry. Accessed November 29, 2023.

Background and Aim

Planning and Execution Details

QI Implementation:

QI tools used to identify possible solutions were as follows: • Brainstorming allowed all team members to participate and develop solutions. Brainstorming also allowed other team members to build on each others' solutions while staying focused on the aim statement. • A solution-and-effect diagram identified areas of solutions with subcategories that would help the team achieve the aim statement. • The impact difficulty matrix was used by considering the solutions identified in the solution-and-effect diagram. The solutions were organized by level of difficulty and ease of solution. This helped the team identify solutions that were quick, easy fixes and those that may require more work or time but would also affect the aim statement. • The nominal group technique with multi-user voting allowed the team to quickly come to a consensus on the importance of solutions while allowing all staff to have a voice. This helped build a level of commitment among the team members and encourage the quieter staff to have a voice. • The Gantt chart is a simple, accessible tool for all staff that showed which tasks could be done over the life of the project and who is responsible. • The roles and responsibilities diagram was developed as part of the Gantt chart and posted, so all staff were aware of their role during the entire course of the project. The following solutions were chosen: 1. Define staff roles and responsibilities. 2. Provide on-site access to data entry through employee Surfaces and multi-user hot spots. 3. Beef up staffing at large outreach clinics. Bring in outside service section help, if needed. 4. Establish responsibility and ownership. 5. Have a competent team approach. All team members were encouraged to use and follow the QI tools developed before making any changes to the process before the first check-in meeting. Following the tools created would distinguish whether any problems occurring were due to the actual process or tool developed or because of personal choices to not complete an assigned task. This project will affect the following customers: • Internal: AIDEP staff who assist in the flu vaccine program, public health nurses, the health promotion manager, and the senior health nurse • External: Medical providers in Iowa (all medical providers, pharmacies), patients who receive these immunizations, Iowa Department of Public Health's Immunization Grant, and Iowa's IRIS

Focus activities

Immunization:

Adult Immunizations- administration of vaccine to population

Childhood Immunizations- administration of vaccine to population

Registry maintenance:

Childhood Immunization

Administration:

Data collection and management/Information Technology

QI Methods:

Nominal Group Technique

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Brainstorming

Fishbone Diagram

Flow chart

Multi- Voting Technique

QI Tool Documentation:

Revised Full GANTT.xlsx

QI Tools.xlsx

Initiative Dates:

3/22/17 to 1/9/18

Initiative Duration:

Between 6-12 months

Methods of evaluation:

Data were provided by the Iowa Department of Public Health's IRIS before, during, and after completing this project. Data entry measured for this project included all patients who received a flu, PCV13, or PPSV23 vaccine from September 1, 2017, through November 30, 2017, by CGCDPH and whether the 7-day data entry goal was achieved.

Other Information:

During the first team meeting, a representative from the Iowa Department of Public Health was shadowing the QI planning meeting and recommended that the aim statement be checked midway through with an obtainable goal.

Supplemental Materials:

Sample of materials produced

Report

Supplemental Files:

Attachment	Size
QI Final Report- BB.docx	625.86 KB

Results

Measurable QI Outcomes:

Check: October 15, 2017, and November 30, 2017 The team checked progress twice during the course of this project. 1. Aim statement: September 1, 2017, through October 15, 2017 Documentation into the state immunization registry for patients served by CGCDPH who receive flu, PCV13, and PPSV23 vaccinations will not exceed 25% over 7 days. • Total vaccines given: 2,018 • Total number exceeding 7 days: 34 • Percentage exceeding 7 days: 1.68% • Goal: 25% 2. Aim statement: October 16, 2017, through November 30, 2017 Documentation into the state immunization registry for patients served by CGCDPH who receive flu, PCV13, and PPSV23 vaccinations will not exceed 5% over 7 days. • Total vaccines given: 1,035 • Total number exceeding 7 days: 7 • Percentage exceeding 7 days: 0.68% • Goal: 5% Overall project statistics: September 1, 2017, through November 30, 2017 • Total vaccines given: 3,053 • Total number exceeding 7 days: 41 • Percentage exceeding 7 days: 1.34% • Goal: 5%

Other QI Outcomes:

Successes • The team completed 55 outreach flu clinics, including the largest schools and businesses, to account for 66% of the total flu and pneumococcal vaccinations administered before the first check-in meeting. • Most IRIS data entry was completed at outreach sites on employee Surfaces. A multi-user Internet hot spot was used, so all staff with Surfaces could enter immunizations into the registry. • Dividing data entry for the large outreach flu clinics (i.e., 90–140 vaccines given) among staff made data entry timeliness fewer than 7 days. This process also helped lighten the workload for all team members, making data entry easier and faster to complete, so staff could focus their time on other responsibilities. • Adding a second administrative assistant and a third nurse at the largest school-based flu clinic created a better workflow for staff and the families served by CGCDPH. The nurses could focus on administering vaccines, while support staff could help direct those receiving vaccines. • Staffing the immunization clinic with the primary nurse and front console staff allowed the AIDEP administrative assistant to help the nurse assigned to the outreach clinic. • One grant for the immunization program was written to not include services for September and October if time did not allow. This allowed the immunization nurse covering the immunization clinic the capability to keep up with IRIS data entry. • The tools created by team members were readily accessible, so all staff knew their roles and responsibilities. • Iowa’s IRIS data exchange specialist quickly provided data for this project via e-mail. Barriers Two specific processes were identified as the sources of data entry exceeding 7 days. From September 1, 2017, through November 30, 2017, this included only 41 out of the 2,971 total vaccines given. 1. Outreach employee flu vaccines administered at the jail had no established process in place. The nurse at the jail administers flu vaccines to county employees and is not set up to enter vaccines into IRIS. The team prefers to do the data entry, and the consent forms must come back to the office for record keeping and billing. • Modifications: The immunization nurse reached out to the jail nurse to determine when consent forms could be picked up weekly. The jail nurse scheduled specific days and times for employees to see her for a flu vaccine. E-mail follow-up was done the Monday after the scheduled employee flu vaccine clinic. The team will discuss possible ideas for improvement at the 2018 flu season planning meeting. 2. The public health nurse flu consent form turn-in bin was not being checked daily. • Modifications: The immunization nurse began checking the immunization consent form turn-in bin daily after a public health nurse contacted her several times that consent forms were not being picked up daily. The team will discuss possible ideas for improvement at the 2018 flu season planning meeting.

Future Plans:

• A Gantt chart will be used for the 2018–2019 flu vaccine season to help all staff know their role and when tasks assigned to them are due by. • The clinic cover sheet and 2018–2019 flu vaccine consent forms will be updated to include areas for improvement. • The team will re-evaluate the public health nurse and outreach jail flu vaccine administration process for timely data entry. • Data entry timeliness will be checked on October 15, 2018, and November 30, 2018, to determine whether the aim statement is being achieved or to help identify areas for improvement. • The team will brainstorm ideas on how to improve insurance information collection at outreach clinics. • Staff will continue to hold themselves accountable for creating a positive team approach.

Improving Immunization Data Entry Timeliness into the State Registry

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Collaborations

Contact Information of the Submitter

QI Spotlight

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Improving Immunization Data Entry Timeliness into the State Registry

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Collaborations

Contact Information of the Submitter

QI Spotlight