2013 CNL® Summit
January 17-19, 2013
Abstract Submission Form
Abstract title: Saving Lives: Clinical Nurse Leader's Impact on Improving Adult Inpatient
Immunization Rates
Authors & credentials: Laurie Sayer MSN RN CNL and Kristin S Mast MSN RN CNL CNRN
Institution: Saint Mary's Health Care
City/State: Grand Rapids, Michigan
Primary Contact Email: sayerl@trinity-health.org
Instructions: Please complete each of the following sections, when applicable. Each section
should contain between 50 and 250 words, using Times New Roman, 12 point font.
Background Information:
Influenza and pneumonia are a major cause of hospitalization and death in the United States. As
a clinician, the CNL promotes better health for populations by creating awareness, knowledge
and system changes to increase the adult inpatient immunization rate. This ensures improved
compliance with the CMS quality of care measures, accountable care, and will have a financial
impact related to pay for performance standards. A higher immunization rate also aligns with
Healthy People 2020 goal of increasing immunization levels and reducing preventable infectious
diseases.
As an organization, Saint Mary's Health Care was not consistently meeting established
benchmarks for pneumonia’s quality core measures. In addition, a baseline audit completed
October to December 2010 indicated that only 51% of patients actually received their ordered
pneumovax vaccine and 41.7% their ordered influenza vaccne prior to discharge.
A CNL led interdisciplinary task force was formed to look at current practice, analyze data,
identify barriers and develop a process improvement plan utilizing LEAN principles. At a system
wide and microsystem level, CNLs support immunization processes by both formal and informal
education, mentoring, system changes, data awareness and accountability.
Aim:
Initially, the goal of this CNL led quality initiative was for 100% of the patients with vaccines
ordered are administered before discharge. Root cause analysis identified complex
immunization assessment issues, lack of knowledge, fear of potential harm with duplicate
vaccines, and lack of accountability as key reasons staff were not changing practice. Ultimately,
we identified we could increase the immunization rate through more accurate screenings of high
risk patients and promote immunization during hospitalization.
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Methods/Programs/Practices:
A root cause analysis was performed with essential input from staff RNs to identify issues
affecting immunization compliance. The team recognized several problems related to the
immunization process but initially targeted the quality of care issue, which was patients having
an active order for a vaccine but the vaccine was not given prior to discharge. Even though the
team initially looked at the pneumonia population for core measure compliance, further
investigation identified we could increase the immunization rate for all adult populations
through more accurate screenings of high risk patients and promotion of immunizations during
hospitalizations.
The team sought input from staff nurses on identifying barriers to vaccine administration. Based
on feedback from staff on all inpatient units the team identified 3 main focus areas; education,
accountability, and continual awareness of vaccine compliance.
The team developed a Vaccination Fast Facts sheet for both influenza and pneumococcal
immunizations given to all RNs which promoted best practices and underlined the importance of
vaccines in saving lives. With manager support, a Just Culture accountability format was created
using the SBAR format along with coaching and counseling tools.
CNLs were champions of the quality initiative. As outcome managers, unit CNLs received daily
and monthly reports to monitor compliance, trends, and evaluate gaps for unit specific
improvement opportunities. Inpatient CNLs have been instrumental in obtaining accurate patient
immunization history. This has created an increased awareness for up to date immunizations and
reduced the occurrence of duplicate immunizations. The CNLs provided education at unit staff
meetings, mentoring on the units, and obtained feedback from the nurses about barriers and gaps
in the process which was then taken back to the team to address. CNLs were also instrumental in
eliminating duplicate vaccinations by researching patient’s vaccine history and updating
immunization histories. The CNLs also received daily reports for active vaccine orders to ensure
just in time education and compliance. Each unit’s pneumovax and influenza monthly data
reports are posted on their Quality Boards for awareness and transparency.
Outcome Data
Utilizing a LEAN process and implementing change strategy at the bedside through the CNL
initiative showed pneumovax and influenza “vaccines ordered and given” increased from a
baseline of less than 52% to 83.6 % .
Conclusion:
Several initiatives at our organization have failed to improve and sustain pneumococcal and
influenza rates for the adult inpatient populations thus affecting the quality of care and safety of
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our patients. A CNL led interdisciplinary initiative utilizing process improvement methods
supported by an accountability model have played an instrumental role in improving and
sustaining the overall vaccination rate for the organization. Ongoing efforts are directed towards
accurately assessing and providing immunizations to every patient, every time.
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