Improving professional practice through audit and feedback: Promoting pneumococcal immunization in Presurgical Testing. Deborah Hodges, MSN, RN, CAPA, CNL; Rebecca Clark, PhD, RN & Kim Carter, PhD, RN, NEA BC

Improving professional practice through audit and feedback: Promoting pneumococcal immunization in Presurgical Testing.

Deborah Hodges, MSN, RN, CAPA, CNL - Presurgical Testing; Rebecca Clark, PhD, RN & Kim Carter, PhD, RN, NEA-BC - Nursing Research

Introduction

It is often challenging to engage nurses in quality improvement. Their participation is essential for an organization to meet established goals. Audit and feedback is a quality improvement strategy used to improve employee performance1. Using the audit and feedback strategy, professionals are provided feedback regarding performance to achieve goals. Audit, coupled with individualized, timely, actionable feedback, provides information for performance improvement.

Pneumococcal pneumonia causes approximately 150,000 hospitalizations annually in the United States, and around 3,600 people died from pneumococcal meningitis and bacteremia in the United States in 20172. Vaccine-preventable illness and death from pneumococcal infections continues to be of concern3.The Centers for Disease Control and Prevention recommends that vaccines be offered in non-traditional settings4. Studies demonstrate that recommendations from nurses and other healthcare providers have a significant impact on immunization rates, yet patients report they often do not receive these recommendations5-6 .

Identification of problem and purpose of study

The department goal was that 50% of eligible patients receive pneumococcal vaccinations, yet the percentage was 33%. The goal of this quality improvement study was to increase the rate of pneumococcal vaccination in our Carilion Presurgical Testing Center by using audit and feedback to achieve the target of immunizing 50% of eligible patients. This work builds upon foundational quality improvement work in the department funded by grants from the Merck, Sharp, & Dohme Investigator Studies Program. .

Methods

Following updates to the electronic medical record (EMR), nurses participated in the establishment of departmental goals and discussed how to promote immunization of eligible patients. EMR reports provided the manager with monthly performance data that she audited and shared, recognizing nurses who met goal, and sending individualized emails providing actionable feedback for those not meeting goal. Other evidence-based strategies that the team implemented included scripting answers to patient questions, unit champions who mentored outliers, and a video created by peers modeling Presurgical Testing Center visits regarding the benefits of vaccination.

Outcomes

From October 2018 to September 2019, all nurses achieved the 50% goal.

Discussion

Setting departmental goals can have limited impact on behavior without ongoing manager involvement. Audit and feedback can assist nurses to understand how their individual performance compares to peers and standards. Peer modeling is useful for those less inclined to participate.

Conclusion

Audit and feedback can help improve professional practice. Leadership involvement combined with peer influence are key factors to successful improvements in adult immunization rates.

Implications for Perianesthesia and future research

Audit and feedback is an effective tool to influence professional practice. Ongoing efforts to increase immunization rates will continue to impact decreased pneumococcal disease in the community and ultimately reduce vaccine-preventable hospitalizations. More study is needed to identify strategies to apply the audit and feedback strategy to support nurses to sustain the pneumococcal goal and to achieve other departmental goals.

References

1. Hysong, S., Smitham, K., SoRelle, R., Amspoker, A., Hughes, A., & Haidet, P. 2018. Mental models of audit and feedback in primary care settings. Implementation Science, 13(73), https://doi.org/10.1186/ s13012-018-0764-3 2. Centers for Disease Control and Prevention. 2019. Pneumococcal Disease. Accessed online at https:// www.cdc.gov/pneumococcal/about/facts.html 3. Pilishvili, T. & Bennett, N. 2015. Pneumococcal disease prevention among adults: Strategies for the use of pneumococcal vaccines. Vaccine, 33(Suppl 4), D60-65. DOI: 10.1016/j.vaccine.2015.05.102 4. National Vaccine Advisory Committee. 2000. Adult immunization programs in nontraditional settings:

Quality standards and guidance for program evaluation: A report of the National Vaccine Advisory

Committee. MMWR, 49(RR01), 1-13. 5. Lau, D., Hu, J., Majumdar, S., Storie, D., Rees, S., & Johnson, J. 2012. Interventions to improve nfluenza and pneumococcal vaccination rates among community-dwelling adults: A systematic review and meta-analysis. Annals of Family Medicine, 10(6), 538-546. 6. Bridges, C., Hurley, L., Williams, W., Ramakrishnan, A., Dean, A., & Groom, A. 2015. Meeting the challenges of immunizing adults. American Journal of Preventive Medicine, 49(6S4), S455-S464.

Acknowledgment: This work builds on earlier work by Rebecca Clark, PhD, RN; Brenda Gilliam, MSN, RN; Julie Jackson, RN; Deborah Hodges, MSN, RN; Kim Carter, PhD, RN, funded in part by the Investigator-Initiated Studies Program of Merck & Co. The opinions expressed in this presentation are those of the authors and do not necessarily represent those of Merck & Co., Inc.

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