Improving Immunization Process


Impact Statement: 
The Snohomish County Health Dept used QI on its immunization process.. By analyzing causes of error, introducing a new and standardized work flow, and using job aids that help to verify client records and data, the immunization error rate was reduced by over 50%.

Aim statement: Reduce the vaccine administration error rate from 5.3 per 1,000 to 4 per 1,000, a reduction of 30%. With more than 15,000 vaccine administrations annually, the program team was interested in improving. Vaccine administration crossed several processes: client health information, intake, immunization information system (IIS), state registry's and health district's electronic records, nurse assessment, and vaccination. Analysis of prior data identified six error types. The definitions of error types were taken from the Quality Data Report provided by the Washington State Immunization Information System (WAIIS). Multiple cause and effect diagrams outlined possible reasons for the error types. Further analysis proved that 80% of the errors were identified in the "additional dose" and "wrong vaccine" categories. Children are protected against 16 diseases. To accomplish that goal, more than 50 injections are received by 18 years of age, including the annual influenza vaccine. The immunization schedule is complex. New combination vaccines make the situation even more complicated. Examples of "additional dose"-type errors were extra hepatitis A-, measles-, or varicella-containing vaccines. "Wrong vaccine" included using a combination vaccine outside the dose range (i.e., a pediatric vaccine that includes diphtheria, tetanus, pertussis, hepatitis B, and polio that can be used only for the first three doses of that series). Why be concerned about extra shots or combination vaccines that are not used with the right schedule? A client may need to return to the clinic to receive the right vaccine, which is expensive and an inconvenience. The root cause of the two types of errors was found to be in the use of the IIS that record vaccine data. The nurse accesses WAIIS externally and compares records before administration. Instituting a must-check WAIIS before vaccine administration has decreased the error rate by 53% from January to August 2012.

Organization that conducted the QI initiative: 
Snohomish Health District (SHD)

Mell, R. Public Health Quality Improvement Exchange. Improving Immunization Process. Fri, 02/24/2017 - 14:40. Available at Accessed May 27, 2018.

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