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Improving Immunizations: A
CQI Approach
Safe & Timely Immunizations Coalition
Last week we learned…
Why influenza is specifically harmful to dialysis patients, and…
Why it is important to immunize
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
What is CQI?
•Improving quality through:–Proactive approach–Optimal orientation –Process focus
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.
PLAN
DOSTUDY
ACT
The CQI Cycle
The Cycle Never Ends…
It just keeps going, and going, and going…
A Cycle for Learning and Improvement
ACT•What changes are to be made?•What will be the next cycle?
PLAN•State the objective•Make predications•Develop a plan to carry out the cycle
DO•Carry out the plan•Document observations•Analyze data
STUDY•Complete analysis•Compare data to prediction•Summarize what was learned
The IHI Model for Improvement
Act Plan
Do Study
• 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?
Understanding the Problem
•Establishing a problem statement
•Defining the scope of the problem
•Refining the problem
Immunizations for Influenza
1. Where are we currently?- What does the data say?-What is the trend?
2. Where do we want to be?- What knowledge do we have?- What is our goal?
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.
USRDS ADR 2007
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)
Where do we want to be?
• Healthy People 2010 Goals– Influenza = 90%– Pneumococcal = 90%– Hepatitis B = 80%
• Network Medical Review Board recommendations
• CDC Guidelines
What Are the Barriers?
How Will We Know a Change Is an
Improvement?• Identify the barriers•How do we measure that barrier?•What does improvement look
like?
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?
Root Cause Analysis
Low immunization
rates
PrescriptionMedical
EducationStaff-RelatedPatient
Technical
HP 2010 Goal
Planning:Key Components of a CQI
Team
• Multidisciplinary• Common goal• Day-to-day knowledge
Planning for Improvement
•Thinking outside the box•Establishing accountability
•Setting a timeframe•Evaluating results•Documenting change
All improvement requires change
but
Not all change is improvement
All improvement requires change
but
Not all change is improvement
REMEMBER
Evaluate the results!
Thinking Outside the Box
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
Establishing Accountability
CREATIVE CHANGE
From the ground up…-Problem identification
-Idea development
From the ground up…-Problem identification
-Idea development
From the top down…-Support-resources
From the top down…-Support-resources
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.
Setting A Timeframe
Evaluate the Results
Document the Change
Resources• Immunization Tools
– www.cdc.gov/vaccines/pubs/downloads/b_dialysis_guide.pdf
– www.esrdnetwork6.org/STICCoalition.htm– www.esrdnet11.org/quality/immunization_coali
tion.asp– www.esrdnet15.org/QI.htm#stic
• CQI Tools– ANNA– ESRD Networks– www.ihi.org
