1 Welcome!  Thank you for joining the American College of Physicians’ Quality Connect Adult Immunization Learning Series Webinar!  We will start in a few minutes.  Today’s webinar is focused on the PDSA cycle.  Please keep your phone on mute, when not asking questions, we are recording this webinar.  Feel free to ask questions in the chat feature of WebEx.  ACP will share the slides and recorded webinar on MedConcert.

2 Today’s Speaker  Kathryn Eiler, CMM, HITCM-PP  Kathryn is a medical practice administrator with over 20+ years of experience in medical practice management. She is a Nationally Certified Medical Manager in both practice management and health information technology for physician practices.  Kathryn is a member of the Faculty of ACP’s, Quality Improvement programs for Vaccines, Diabetes, Cardiovascular Disease, Management and Education. Kathryn has been teaching practice administrators and physicians how to streamline care to meet the quality benchmarks and implement a team approach to patient care.

3 Raising Your Rates – Developing Your PDSA: A Journey In Improving The Vaccine Rates In Your Practice Kathryn Eiler CMM, HITCM-PP September 16, 2015 Adult Immunization Learning Series Webinar

4 Webinar Learning Objectives  Learn more about the Plan, Do, Study, Act (PDSA) quality improvement cycle to increase adult immunization rates in your practice.  Learn practice team strategies to implement PDSAs focused on adult immunization for long term results.  Assess best practices by reviewing examples featuring adult immunization topics.

5 Improving Vaccine Rates One Patient at Time  The first step in improving vaccine rates is to look at how you deliver care to your patients.  Delivering care that is team based is much easier. You are more likely to be very successful. Your patient’s will be happier. Your team is more likely to love what they do at the end of the day.  Identify a need, set a goal, make a plan, try it, and improve the process.

6 Identify a Need – Set a Goal – Make a Plan  Conduct a Plan, Do, Study, Act cycle (PDSA)  You have identified a need to vaccinate every patient with seasonal influenza vaccine and, where applicable, give them the Pneumovax vaccine this season as well.  Goal: To increase vaccine rates for seasonal influenza and Pneumovax from September 2015 to June 2016 by 50%

7 PDSA – Plan  Identify a team that includes a physician, administrative employee, and medical assistant or nurse.  To start, schedule a full day with team to exercise quality improvement (QI) methods.  Implement the QI methods during the full day exercise in QI and repeat the improvement process along the way.  Each member of the team will have specific responsibilities to engage, inform, and educate the patient.  The physician should develop specific protocols to help the team identify patients, who are in need of vaccines.  The team should use a patient handout to share why vaccines are important.

8 PDSA – Do  Assign each team member a task – during the morning team meeting, before you see patients.  Identify each patient who will need vaccinating.  Mark your schedules to highlight those patients.  The front desk staff should give the handout to patients.  The medical assistant/nurse rooms the patient and says “We are approaching this year’s cold and flu season and our goal is to make sure we do everything we can to keep you healthy. Dr. Smith will be talking to you today about these vaccinations at your visit.”

9 PDSA – Study  At the end of the day, the administrative/front desk staff will determine: How many of the day’s patients were vaccinated. Have a plan to receive the vaccine(s) in the near future.

10 PDSA – Act  Team will meet again to review the outcome/success of the day, mark date and outcome on a timeline.  New plan will be made to increase the success next week. Ask your patients as they check out, if they received their vaccine(s), if not, ask why?  Identify barriers to your success along the way to help improve the process.

11 Team Based Care Starts Here  Look at the process of determining what vaccines your patients need most – for example, seasonal influenza and Pneumovax.  Your team will look at the schedule and identify a specific day to begin the process. Select a day in your schedule you want to start. Identify patients in that schedule that need these vaccines. Each member of the team will begin to communicate with the patients you have identified on that day. You need to vaccinate the patient while they in the office or help to make a plan to for the patient at another time. Keep your process simple.

12 Benefits of Team Based Care  The responsibility to inform, educate, and vaccinate is equally shared by every member of the team.  This process will insure that no one person is overburdened and falling short of reaching the goals set by the team.  When the patient is included in the team’s process, it is easier for the team to identify barriers to success and set new goals for improvement.  Each time you reach your goal, celebrate your success! Post your timeline where everyone can see it! Be proud of what you are doing!  Remember to start small, keep it simple, one patient at a time, is the key to your success.

13 Why Track Your Weekly Progress  Your journey to improve your vaccination rates and reach your goal can only work if you: Stick with your plan. Track your progress. Make adjustments along the way to help improve the process. Post your results. Celebrate your team’s success. It will become a part of how you deliver vaccine care to every patient in your practice.

14 Keep Focused on Long Term Results  Team based care and the process of redesigning how you deliver care to your patients, will help you and your team feel better about what you do everyday.  As you see success, there is MAGIC that happens! You will begin to use this same process to implement, improve, and change how you deliver care to your patients everyday!  Patient’s are happier and healthier!  Your team is happier and no one person is overburdened in the process!  Your quality measures will begin to reach for the stars!

15 Managing Vaccines in Your Practice  Think about the important considerations in your journey for raising the adult immunization rates. Who manages the ordering of vaccines? How do they determine what is needed and when to order? What can your practice afford? – some vaccines are very expensive. How does your practice partner with the local pharmacies? Health departments? The emergency rooms? Urgent care centers?

16 Vaccine Care and Delivery  In your quest to improve vaccine rates, you will want to make sure you are doing things correctly, and protecting your investment along the way.  Every vaccine comes with a package insert, that explains the storage requirements to keep the vaccine viable. Make sure your staff knows what is the recommended temperature range is for each vaccine – not all vaccines have the same temperature range.  Install thermometers in your vaccine refrigerators – some vaccines required temperatures to be recorded twice daily.

17 Vaccine Care and Delivery (cont.)  Be sure your staff provides the Vaccine Information Statements (VIS) to every patient. The medical record should document that the patient received the VIS and consented to the administration of the vaccine. It is law to provide the VIS. If you need up-to-date VIS, go to and be sure to print the latest version.

18 Staff Protocols Can Help the Process  In your daily practice of medicine, opportunities are lost simply because the staff are not aware of patient vaccine needs.  Physicians should develop protocols for every vaccine. Simple instructions that educate the staff, by vaccine, when to pursue an opportunity to vaccinate with patients. Unlike standing orders, these protocols will help you determine when a vaccine is needed.  Example: A patient presents to the front desk for his/her appointment and while checking in they are so happy to tell everyone they have a new grandchild they will be visiting or watching. This is a great opportunity to educate and vaccinate for TDAP, in an otherwise healthy patient that may not be on your radar for this vaccine!

19 Vaccine Clinic 1, 2, 3’s  Many practices are overwhelmed at just the thought of vaccine clinics. Some immediately think mass chaos!  Challenge yourself to think outside the box. What if you could offer vaccines when your practice isn’t a busy? What if you could schedule, advertise, and offer vaccines at an alternate location? (Such as a the lobby of your building) Patients report they love the vaccine clinics because they don’t have to wait but come in get the shot, sign the form, and they are on their way.  Start small – schedule only a few vaccinations at a time. Evaluate the process and then make a plan to expand.

20 Have Tools to Address Barriers to Success  Every practice should have a toolbox.  The toolbox should have options to help solve problems that your team identifies as a barrier to success.  Every time you encounter a problem, staff have an approved solution and are empowered to solve it.  Toolboxes don’t happen overnight but develop along the way.  Successful physician practices, always have a toolbox, and has a variety of solutions that everyone can use.  Every member of the team is important and equally empowered to help!

21 Creative Solutions to Delivering Care  The best advice is to think outside the box!  If your practice is having trouble getting vaccine information from the local pharmacies: Have your practice administrator stop by and provide a simple form to complete and fax to the practice each time a patient presents for a vaccine.  Partner with local pharmacies, the ER, and the urgent care centers to help you in your quest to RAISE THE RATES! Health department may be able to vaccinate, and if you have children in your practice, sometimes schools or colleges may offer vaccines.

22 Creative Solutions (cont.)  If you have an EHR, use the prompts that ask, “Have you had your influenza vaccine?”  Specialty practices are being graded on quality benchmarks for vaccine compliance. Make sure you are recording vaccines administered to patients in other locations – reach out to your referring physicians.  Build relationships while providing quality care is a win-win for your practice and your patients.

23 Learn to Love the Process!  Once you see how easy team based care is to deliver you will choose to design every visit this way! Remember to start small. Set a goal. Choose your team. Make a plan and implement. Record your progress. Make improvements as needed. Repeat!

24 Questions  Contact Information: Kathryn Eiler –