13 by 2 Pediatric Immunizations Eban Experience Session II June 17, 2011

Aim Goal – Increase the 2 year old immunization up-to-date rate for East African children who receive care at Brooklyn Center or Riverside Clinics. Aim – Decrease the number of African American or Black children who are months of age and not up-to-date with immunizations to <2/clinic.

Project Team Nora Ali, community member Said Ali, interpreter, Riverside Clinic Surra Benti, community member Sandi Broberg, RN, Brooklyn Center Clinic Dave Griffin, MD, Woodbury Clinic Judy Jerde, nursing project coordinator Deb Johnson, MD, Riverside Clinic Jen Pfeiffer, LPN, Riverside Clinic Dana Langness, quality coordinator

Workflow – as is No

Workflow – as is

PDSA # – 2 Objective Administer immunizations to African American or Black children who are 3-23 months and seen for an illness visit or are ill at the time of a well child visit who have immunizations that are due or overdue. Predictions HPMG employed interpreters, rooming and provider staff will consistently recommend immunizations when there is not a medical contraindication or will ask the parent to schedule a nurse appointment if the vaccines are not administered at the visit. Some parents will have their child immunized at the time of the visit. Some parents will return later for a nurse appointment to have their child receive needed immunizations. Population African American or Black children who are 3-23 months and seen at Brooklyn Center or Riverside for an illness visit or are ill at the time of a well child visit who have immunizations that are due or overdue. Plan-Do-Study-Act (PDSA) Cycles:

PDSA # - 2 TEST CYCLE 1Start Date: 5/20/11 End Date: 6/9/11 Plan Staff education: review illness immunization contraindications with clinic staff to answer questions, assure consistent messaging to parents and knowledge of this intervention. Ill visit process: identify children who need immunizations, inform parent and provide information, provider discusses with parent, if parent declines, “nurse referral” to return in 1-2 wks. Do Brooklyn Center – 10 patients, 1 received immunizations, 1 returned, 1 with contraindication, 5 parents declined, 2 unknown Riverside – 9 patients, 4 received immunizations, 1 with contraindication, 4 parents declined Study Collect data re: how many parents bring child back for immunizations “It is OK” information sheet is a good visual Engaging and educating staff is critical – it gives parents confidence that it’s OK to immunize Act Further reinforcement with staff Better utilization of “It is OK” information sheet Spread learnings

PDSA # – 3 Objective Administer immunizations to African American or Black children who are 2-23 months whose parents who have concerns about vaccine safety. Prediction Some parents will chose to have their children receive the recommended vaccines per schedule. Population African American or Black children who are 3-23 months and seen at Brooklyn Center or Riverside whose parents are hesitant to have their child receive immunizations. Plan-Do-Study-Act (PDSA) Cycles:

PDSA # - 3 TEST CYCLE 1Start Date: 5/20/11 End Date: continuing Plan Patient awareness: post “Vaccination FACTS” in exam room & provide parents with “Small Steps Can Save Small Lives”. Parent discussion: determine cause for concern, acknowledge concerns about safety as sign of good parenting, stress lives saved & illness prevented as result of immunizations, use CASE model for conversation about vaccine safety. Do Brooklyn Center – 0 patients Riverside – 5 patients Study Not enough data to evaluate, expand through 5 yrs of age, continue this cycle Some children have “Delayed immunizations” on Epic Problem list, but there isn’t information about the delay in the Comments Act Ask providers & nurses to use Problem List to communicate information about delayed immunizations

How have you integrated your community advisor into your improvement work? Attend team meetings Participate in meeting discussions Suggested ways that they can assist with the project “Non-community” team members have learned about East African community, including how to better partner with community to increase immunization rates

Successes & Challenges Successes –Three PDSA cycles Challenges –Time! –How to better utilize community members and implement interventions outside of the clinic setting