Increasing Pneumococcal Vaccination Coverage Rates for Seniors in Cerro Gordo County

Once the QI team articulated the aim statement, they used a force-and-effect diagram and a cause-and-effect diagram to determine the root causes of the low vaccination rates. The next step was to create a solution-and-effect diagram and identify the themes that emerged. Using the nominal group technique, the team identified the priority themes to address. They then ranked all the possible solutions for these themes and chose the ones that were categorized as low difficulty/high impact (and discarded the high-difficulty/low-impact solutions). They developed a Gantt chart to show the tasks, their sequence (and to see all that would be done simultaneously over the life of the project), their deadlines, and the team members responsible for each. All of these completed tools are attached to this submission. The solutions affected CGCDPH nurses, administrative aides, the manager, the public information officer, county residents aged 65 or older, and other vaccine providers. The team members implemented the following solutions: • Worked with the public information officer to include in media advertisements and influenza vaccine promotions a notice that pneumococcal vaccines are readily available for all clinics. • Developed a postcard reminder to hand to the patient that included all vaccines recommended, along with the CGCDPH immunization clinic's contact information if a patient refused the pneumococcal vaccine when they received the influenza vaccine. Postcards were also given to local physician offices to distribute to their patients if referring them to get the vaccine elsewhere. • Educated all nursing staff and direct administrative staff at CGCDPH on ACIP pneumococcal recommendations. • Created laminated pneumococcal vaccine dosing reference sheets for immunization and outreach influenza clinics; educated staff and asked them to keep the sheets on the table as a visual reminder. • Encouraged all staff members, including the administrative intake staff, to provide a strong recommendation for patients to receive the pneumococcal vaccine at the same time they receive the influenza vaccine. • Educated patients and staff members on the difference between the two pneumococcal vaccines available and the importance of receiving them. • Reviewed the CGCDPH home care division patients’ vaccination needs before nurses made home visits and ensured that they brought appropriate vaccines with them. • Provided all nurses at CGCDPH with access to Microsoft Surface and Bluetooth devices at outreach clinics to review all patients’ immunization records. • Conducted a county-wide assessment to determine which agencies (e.g., pharmacies, nursing homes, assisted living centers, medical providers) routinely access and record vaccinations into IRIS, notified agencies of new recommendations, and encouraged routine submissions to IRIS.

County-wide pneumococcal vaccination coverage rates and total pneumococcal vaccine doses administered by CGCDPH were measured from the previous year (July 1, 2014–January 31, 2015) and compared with this year's completion coverage percentiles during the QI project (July 1, 2015–January 31, 2016).