KEYWORD1:
immunization registry; data entry, nurse practice

BACKGROUND:
Manual documentation of vaccine administration involves recording data in multiple locations, including chart notes, flow sheets, encounter forms, and vaccine log books. The use of an immunization registry allows for automation of some of these procedures at the point of service. In 2000, we launched an immunization registry at a practice network in a low-income community in NYC to assist with these tasks.

OBJECTIVE:
To evaluate nursing time spent documenting vaccine administration before and after implementation of an immunization registry.

METHOD:
Baseline and 2-years after implementation of the immunization registry, we conducted an observational study of nursing vaccination documentation activities at a practice network. Time was assessed for: completing immunization flowsheet, documenting patient education, vaccine order verification and signature, VFC form completion, and update of parent hand-held record. Post-implementation observations included these same tasks plus data entry in registry .

RESULT:
151 observations were made, 85 pre- and 66 post-implementation of the registry. Average nurse time increased from 2.0 minutes to 3.5 minutes.

CONCLUSION:
The immunization registry nearly doubled the nursing time required to document vaccine administration. This additional time may be viewed as an upfront investment with significant potential for: 1) improved data quality, 2) vaccine inventory tracking and management, 3) quick access to individual and aggregate vaccination information for up-to-date assessment, quality improvement initiatives, or regulatory reporting mandates, and 4) improved risk management as a result of reduced response times and comprehensive information retrieval in the event of a vaccine recall or adverse event.
LEARNINGOBJECTIVES:
Use of a time-motion study to assess immunization registry utilization efficiency