2.50
Hdl Handle:
http://hdl.handle.net/10755/164156
Category:
Abstract
Type:
Presentation
Title:
Multidisciplinary approach to implementing a CMS-compliant Vaccination Protocol
Author(s):
Shambarger, Maurine; Snyder, Lori
Author Details:
Maurine Shambarger, MSN, RN, CNS, Saint Elizabeth Regional Medical Center, Lincoln, Nebraska, USA, email: nacnsorg@nacns.org; Lori Snyder, MSN, RN ,CIC
Abstract:
Problem and Significance : Noting that pneumococcal disease and influenza together are the fifth leading cause of death in the United States among persons aged 65 years or older, the Centers for Medicare and Medicaid Services (CMS), in partnership with Centers for Disease Control (CDC) and others, have targeted vaccination with their Influenza/Pneumococcal Campaign. U.S. immunization rates for pneumococcal vaccination have increased to 54.1 percent and influenza vaccination to 66.9 percent for persons aged 65 years and older in 1999, however the Leading Health Indicators established by Healthy People 2010 target both of these vaccination rates to reach 90 percent for this population. CDC recommends that all persons receive a dose of pneumococcal vaccination when or after they reach age 65 and that all persons with unknown vaccination status should receive one dose of vaccine. This vaccination can be given anytime during the year and is generally once-in-a-lifetime after age 65. Likewise they recommend all persons receive an annual dose of influenza vaccine between October and November, and include persons >65 years in the high priority target group of those at increased risk for complications from influenza. While widely recognized as a noble objective, vaccination of at-risk individuals is problematic for several reasons: overcoming the logistic barriers of patients moving back-and-forth through a complex and fragmented healthcare continuum; bridging the gap of discrepancies between nurses, physicians and pharmacists about the "ownership" of medication administration, and finally, effecting a change in healthcare organizational culture from 1) a Medical model to an interdisciplinary patient-focused model and 2) from acute care to a prevention model. Purpose of the project: The purpose of this project was to develop a seamless and consistent system for vaccinating high-risk patients as recommended by the Centers for Medicare & Medicaid Services. Objectives: The objective of the project was to fulfill our Catholic Health Initiatives value of excellence in our ability to serve the community by vaccinating eligible patients in order to reduce morbidity and mortality associated with vaccine preventable illness, and to do so in a manner which causes minimal disruption of acute care and provides communication back to the primary care provider and other healthcare providers in the continuum. Description of Project: The CNS and the Infection Control Nurse undertook development of a process to order, dispense, administer and document routine Influenza and Pneumococcal vaccine of at-risk patients without the order of a physician. Methods: A small multi-disciplinary committee was assembled to consider this possibility. Guidelines and recommendations were reviewed and national practices benchmarked prior to flow-charting the ideal process and developing related documents. Input from medical staff, nurses, and pharmacists was sought along the development process. An attempt at medical staff committee approval resulted in significant concerns with the ability to communicate vaccination within the community, resulting in the over-vaccination of the population requiring multiple admissions to institutions. With these concerns in mind, the decision-making process was expanded to include members of the healthcare continuum. Consensus was quickly reached that the good of the patient requires that all members of the healthcare continuum use better communication to achieve the standard desired, including improved use of documentation and technology. Medical Staff approval was granted for a pilot project on the Medical/Oncology unit for patients 65 years and older. Education was conducted prior to launching the pilot.Outcomes and Evaluation: This is a work in progress. In the first month, pre- or during hospitalization vaccination was received by 91% (Influenza) and 89% (Pneumovax) of patients. Process problems identified during this early phase are currently being addressed prior to expansion of the pilot to include at-risk patients admitted anywhere in the Medical Center. Conclusions/Implications for Nursing Practice: Clinical nurse specialists can be successful in changing the culture from a medical model to a multi-disciplinary approach to providing wellness services that bridges the gaps in services. The project also demonstrated that as the healthcare continuum becomes more fluid, lessons learned and electronic communication can prevent duplication of services and gaps in care.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2005
Conference Name:
CNS Leadership: Navigating the Healthcare Environment Toward Excellence
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Orlando, Florida, USA
Description:
Conference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleMultidisciplinary approach to implementing a CMS-compliant Vaccination Protocolen_GB
dc.contributor.authorShambarger, Maurineen_US
dc.contributor.authorSnyder, Lorien_US
dc.author.detailsMaurine Shambarger, MSN, RN, CNS, Saint Elizabeth Regional Medical Center, Lincoln, Nebraska, USA, email: nacnsorg@nacns.org; Lori Snyder, MSN, RN ,CICen_US
dc.identifier.urihttp://hdl.handle.net/10755/164156-
dc.description.abstractProblem and Significance : Noting that pneumococcal disease and influenza together are the fifth leading cause of death in the United States among persons aged 65 years or older, the Centers for Medicare and Medicaid Services (CMS), in partnership with Centers for Disease Control (CDC) and others, have targeted vaccination with their Influenza/Pneumococcal Campaign. U.S. immunization rates for pneumococcal vaccination have increased to 54.1 percent and influenza vaccination to 66.9 percent for persons aged 65 years and older in 1999, however the Leading Health Indicators established by Healthy People 2010 target both of these vaccination rates to reach 90 percent for this population. CDC recommends that all persons receive a dose of pneumococcal vaccination when or after they reach age 65 and that all persons with unknown vaccination status should receive one dose of vaccine. This vaccination can be given anytime during the year and is generally once-in-a-lifetime after age 65. Likewise they recommend all persons receive an annual dose of influenza vaccine between October and November, and include persons >65 years in the high priority target group of those at increased risk for complications from influenza. While widely recognized as a noble objective, vaccination of at-risk individuals is problematic for several reasons: overcoming the logistic barriers of patients moving back-and-forth through a complex and fragmented healthcare continuum; bridging the gap of discrepancies between nurses, physicians and pharmacists about the "ownership" of medication administration, and finally, effecting a change in healthcare organizational culture from 1) a Medical model to an interdisciplinary patient-focused model and 2) from acute care to a prevention model. Purpose of the project: The purpose of this project was to develop a seamless and consistent system for vaccinating high-risk patients as recommended by the Centers for Medicare & Medicaid Services. Objectives: The objective of the project was to fulfill our Catholic Health Initiatives value of excellence in our ability to serve the community by vaccinating eligible patients in order to reduce morbidity and mortality associated with vaccine preventable illness, and to do so in a manner which causes minimal disruption of acute care and provides communication back to the primary care provider and other healthcare providers in the continuum. Description of Project: The CNS and the Infection Control Nurse undertook development of a process to order, dispense, administer and document routine Influenza and Pneumococcal vaccine of at-risk patients without the order of a physician. Methods: A small multi-disciplinary committee was assembled to consider this possibility. Guidelines and recommendations were reviewed and national practices benchmarked prior to flow-charting the ideal process and developing related documents. Input from medical staff, nurses, and pharmacists was sought along the development process. An attempt at medical staff committee approval resulted in significant concerns with the ability to communicate vaccination within the community, resulting in the over-vaccination of the population requiring multiple admissions to institutions. With these concerns in mind, the decision-making process was expanded to include members of the healthcare continuum. Consensus was quickly reached that the good of the patient requires that all members of the healthcare continuum use better communication to achieve the standard desired, including improved use of documentation and technology. Medical Staff approval was granted for a pilot project on the Medical/Oncology unit for patients 65 years and older. Education was conducted prior to launching the pilot.Outcomes and Evaluation: This is a work in progress. In the first month, pre- or during hospitalization vaccination was received by 91% (Influenza) and 89% (Pneumovax) of patients. Process problems identified during this early phase are currently being addressed prior to expansion of the pilot to include at-risk patients admitted anywhere in the Medical Center. Conclusions/Implications for Nursing Practice: Clinical nurse specialists can be successful in changing the culture from a medical model to a multi-disciplinary approach to providing wellness services that bridges the gaps in services. The project also demonstrated that as the healthcare continuum becomes more fluid, lessons learned and electronic communication can prevent duplication of services and gaps in care.en_GB
dc.date.available2011-10-27T11:43:04Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:43:04Z-
dc.conference.date2005en_US
dc.conference.nameCNS Leadership: Navigating the Healthcare Environment Toward Excellenceen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationOrlando, Florida, USAen_US
dc.descriptionConference theme: CNS Leadership: Navigating the Healthcare Environment Toward Excellence, held on March 9�12, 2005 in Orlando, Florida, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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