November 30, 2010

As in any healthcare system, a “paper trail” exists from the time an order for an immunization is written until the actual administration and accompanying documentation is recorded. As a check on how well the NCIR was being used, the pilot team compared pharmacy records to the NCIR records in July and again in October and found 99% agreement. This is a high level of reliability and speaks to the hard work of the team to develop a reliable system. Currently the team is completing the name reconciliation for the infants entered over the summer and creating a graphic of the unit process for using the registry. The last activity of the pilot will be to plan system checks and agree on periodic system sampling to assure that there is not falloff or drift from the current achievements.

October 30, 2010

One of the important features of the North Carolina Immunization Registry (NCIR) is the ability to print an official immunization record for the parents at the time of discharge. In order for the record to be official it must be stamped with the official seal and the team has designed a process to keep up with the stamp. Attention to these types of details as well as the ability to create a process map for using the registry will contribute to the design of a system that is hardwired, non-variable and reproducible in another sector of the hospital.

September 30, 2010

Evaluations of the pilot phase using the North Carolina Immunization Registry (NCIR) for babies in the Newborn Critical Care center at NC Children’s Hospital revealed several learning and improvement opportunities. The nursery is a large service admitting more than 700 patients a year. Initial unit training included both the nursing staff and the unit clerks; however the opportunity to use the registry was not frequent enough to maintain competency among a large group. The unit is trialing using a smaller group of nurses to enter the information into NCIR. Additionally, the potential for duplicate records was increased because often patient names were not reconciled at discharge. The unit is trialing delayed entry into the registry until the legal name is verified. These examples of small tests of change will create a system that is robust and reproducible.

August 9, 2010

The pilot phase using the North Carolina Immunization Registry (NCIR) in the Newborn Critical Care Center at NC Children’s Hospital ended on July 31 and the staff nurses and managers are evaluating their processes and results. This information will be used with evaluations from the NCIR to plan future trainings for  Newborn Critical Care Centers in North Carolina. Although a relatively few immunizations are given to babies recovering from critical illnesses or the consequences of prematurity, this initiative will provide critical information to providers who assume primary care of the babies who graduate from intensive care units.

June 3, 2010

The unit has audited the patient enrollment process and found all patients have been enrolled who were admitted after the initial training. Currently, members of the unit plan to compare the pharmacy log of immunizations to the registry to check the reliability of the information entered into the registry. The remaining challenge is to create a system that does not rely on memory alone to assure that every immunization is recorded in the NCIR. This team has embraced this work and is well on the way to achieving their dual aim: To enroll 95% of all admitted newborns into the NCIR and to record 95% of all immunizations given in the NCCC into the NCIR.

May 1, 2010

On 29 April 2010 fifty-six staff members from the NC Children’s Hospital Newborn Critical Care Center (NCCC) attended a training session with staff from the NC Immunization Branch. The remainder of the staff was oriented to the North Carolina Immunization Registry (NCIR), enrolled as typical users, and are ready to record all immunizations. Health Unit Coordinators enter each patient admitted to the registry and at the time of discharge; parents are given an official “shot record” printed from the registry website.

April 13, 2010
A small team lead by Cathleen Dehn, Clara Alston and Megan Popielarczyk has planned the training and implementation of the North Carolina Immunization Registry in the Newborn Critical Care Center in the North Carolina Children’s Hospital. Ashley Graham is the lead instructor from the Immunization Branch and 30+ nurses will receive the training on 29 April 2010.
January 28, 2010
Our young collaborative is a “learning organization” and a sage once remarked that we might experience the same problems over and over until our learning has advance beyond novice on the subject. After several “fits and starts” with the immunization Initiative, we are poised to begin at the NC Children’s Hospital at UNC. The new Nurse Manager, Cathleen Dehn, has agreed to work with our new Clinical Lead and  graduate student, Megan Popielarczyk,  Jason Blevins, also a graduate student and a representative from the NC Immunization Branch to pilot the program. Jason has already created several learning modules;  the timeline, milestones and role definitions will be agreed upon within a month. The revised aim of this initiative is to prototype, pilot, and evaluate the enrollment of newborns into the NCIR prior to hospital discharge from the Newborn critical Care Center in the NC Children’s Hospital. We will be looking for additional NCCC’s to implement the initiative in the summer and fall of 2010.
July 13, 2009
Linda Kessler, RN, at WakeMed has joined the Initiative as a content developer and has a particular interest in how this project will be designed to get the results we need! Linda has many years of experience in Newborn Critical Care and a style of teaching that engages both experienced and new neonatal professionals. Jason Blevins, BS, has also joined the Initiative to provide assistance in two areas: measurement/evaluation and working with PQCNC to provide some computer based modules to support the training effort as we bring more centers in. Jason is a student in the School of Public Health @ UNC and has chosen this work for his practicum. We are delighted to have these individuals onboard with the Immunization Initiative. During August and September the training module will be completed and piloted in 4 nurseries.
July 12, 2009
Joy Sweeney of the North Carolina Immunization Branch prepared materials and provided “first draft” of training designed for Newborn Critical Care Centers to pilot using the North Carolina Immunization Registry. Alamance Regional Hospital, NC Children’s Hospital, Duke Children’s Hospital and WakeMed have agreed to help pilot this training and participants gave feedback about the training and about the components of getting this implemented in these settings. The NCIR is established in North Carolina and a patient is currently entered in an ambulatory setting. Since most newborns are receiving immunizations prior to discharge, the advantages of enrolling the newborn and recording immunizations is appreciated by both families and providers. The next steps will involve creating training content and a training mechanism for these pilot hospitals, implementing the program and creating the necessary adjustments before spreading it to other facilities.