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.
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.
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.
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.
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.
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.