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Improving Immunizations: A CQI Approach

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  1. Improving Immunizations: A CQI Approach

  2. Last week we learned… Why influenza is specifically harmful to dialysis patients, and… Why it is important to immunize

  3. Today we will talk about… • How to use CQI to improve vaccination rates • How to identify common barriers • How to develop strategies for overcoming the barriers

  4. What is CQI? • Improving quality through: • Proactive approach • Optimal orientation • Process focus

  5. What is CQI? • Improvement comes from the application of knowledge. • Any approach to improvement must be based on building and applying knowledge. • Significant, long-term, positive impact occur only when someone takes the initiative.

  6. The CQI Cycle PLAN ACT DO STUDY The Cycle Never Ends…

  7. It just keeps going, and going, and going…

  8. ACT PLAN • What changes are to be made? • What will be the next cycle? • State the objective • Make predications • Develop a plan to carry out the cycle STUDY DO • Complete analysis • Compare data to prediction • Summarize what was learned • Carry out the plan • Document observations • Analyze data A Cycle for Learning and Improvement

  9. The IHI Model for Improvement • What are we trying to • accomplish? • How will we know that a • change is an improvement? • What changes can we • make that will result in • an improvement? Act Plan Study Do

  10. Understanding the Problem • Establishing a problem statement • Defining the scope of the problem • Refining the problem

  11. Immunizations for Influenza • Where are we currently? - What does the data say? -What is the trend? • Where do we want to be? - What knowledge do we have? - What is our goal?

  12. Where Are We Now? ESRD patients initiating therapy at least 90 days before September 1, 2005, & alive on December 31, 2005; vaccinations tracked between September 1 & December 31. illi illi lla lla USRDS ADR 2007

  13. What Knowledge Do We Have? • Increased susceptibility of CKD patients to pneumococcal and hepatitis B (CDC) • Failure to increase rates of immunization over past 10 years (USRDS)

  14. Where do we want to be? • Healthy People 2010 Goals • Influenza = 90% • Pneumococcal = 90% • Hepatitis B = 80% • Network Medical Review Board recommendations • CDC Guidelines

  15. What Are the Barriers?

  16. How Will We Know a Change Is an Improvement? • Identify the barriers • How do we measure that barrier? • What does improvement look like?

  17. Identifying the Causes • Which root causes are are specific to this dialysis unit? • What barriers create this cause? • What strategies can be implemented to overcome the barriers?

  18. Medical Prescription Technical Patient Staff-Related Education Root Cause Analysis Low immunization rates HP 2010 Goal

  19. Planning:Key Components of a CQI Team • Multidisciplinary • Common goal • Day-to-day knowledge

  20. Planning for Improvement • Thinking outside the box • Establishing accountability • Setting a timeframe • Evaluating results • Documenting change

  21. REMEMBER All improvement requires change but Not all change is improvement Evaluate the results!

  22. Thinking Outside the Box

  23. Rules of Creativity • Challenge the boundaries • Rearrange the order of the steps • Look for ways to smooth the flow • Evaluate the purpose • Visualize the idea • Remove “the current way of doing things” as an option

  24. Establishing Accountability

  25. CREATIVE CHANGE • From the top down… • Support • resources • From the ground up… • Problem identification • Idea development

  26. Implementing Change • When given a choice between two systems, one of which they understand, people will use what they know. • If you want to truly make a change, you must present an expectation and put in place a structure to effect the change. • People need information in order to change.

  27. Setting A Timeframe

  28. Evaluate the Results

  29. Document the Change

  30. Resources • Immunization Tools • www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guide.pdf • www.esrdnetwork6.org/STICCoalition.htm • www.esrdnet11.org/quality/immunization_coalition.asp • www.esrdnet15.org/QI.htm#stic • CQI Tools • ANNA • ESRD Networks • www.ihi.org

  31. Questions?Lsauls@nw6.esrd.netjdeane@nw11.esrd.netkstrott@nw15.esrd.netQuestions?Lsauls@nw6.esrd.netjdeane@nw11.esrd.netkstrott@nw15.esrd.net