1. Influenza Screening and Vaccination: A Quality Improvement Opportunity

2. 2009-2010 Retirement Goal # 2 Seasonal flu vaccination (not H1N1) - 90% goal for all patients admitted with pneumonia (Joint Commission requirement) -60% goal for “at risk populations” -Ambulatory and Inpatient encounters in denominator –Internal Medicine, Family Medicine, Obstetrics and Gynecology -Completion of order to give or documentation of exclusion meets criteria -Pediatric encounters are evaluated on first order given only -Periods of vaccine shortage excluded 2

3. Seasonal Influenza 2009-10: Background CDC Recommendation: Annual immunization of all high risk populations and their close contacts:  Persons aged 6 mo to 18 yrs, and > 50  Pregnancy or anticipated pregnancy during flu season  Persons w chronic cardiopulmonary, metabolic, renal, neurologic/neuromuscular, hematological conditions  Persons with drug-induced immunosuppression or HIV  Residents of nursing homes and long-term care facilities  Health Care Workers 3

4. Background: How have we done nationally? Influenza vaccination coverage levels from 2007-08 Season Persons w High Risk ConditionsCoverage Persons wo HR ConditionsCoverage 18-49 yrs30%Pregnant women24% 50-64 yrs48%*HC workers44% * 06-07 data 4

5. How are we doing at OHSU? Core Measure Compliance: Pneumonia Publicly reported data, based on record abstraction, on compliance w identified best practices in a selected population OHSU commitment to > 90% compliance Elements most resistant to improvement: Screening and Immunization as appropriate OHSU Compliance w Influenza S & I Q1 07Q4 07Q1 08Q4 08Q1 09 44% 64%77%69%71% 5

6. New Opportunity to Improve Compliance EPIC: Epic Functionality in Place Ambulatory Workflow for Immunizations (adult) Adult Inpatient Workflow Under Development: Pediatric Workflow Clarity Reports to Monitor Compliance 6

7. Influenza orders inserted in widely used Admission Order Sets Prompt regarding best practice Order to give is checked in most order sets Select Contraindications to document rationale for excluding patient from immunization

8. …which opens dropdown menu for documentation of patient-specific exclusion.

9. After Admission: Best Practice Alert Fires on all patients who meet age criteria, who have no documented history of immunization this season. Like original order, links to order to give, and to menu for documentation of contraindications Completion of either order satisfies Best Practice Alert 9

11. Questions? 11