A Quality Improvement System to Reduce the Rate of Invalid Immunizations

Learning Objectives for this Presentation:
By the end of the presentation, participants will be able to:
1. Apply quality improvement measures to reduce the incidence of invalid doses.
2. Use each invalid dose as an opportunity for staff education.

Background:
Invalid immunizations can decrease the effectiveness of the vaccine, alter the immunization schedule, and may result in the unnecessary use of vaccines. Northeast Valley Health Corporation (NEVHC) currently provides over 34,000 immunization encounters a year. The Los Angeles-Orange Immunization Network, LINK, is used to assess and document all immunizations.

Objectives:
NEVHC has implemented a quality improvement system to monitor and reduce the incidence of invalid immunizations. The goal of the organization is to ensure that the rate of invalid doses remains under 2% of the total number of patients immunized.

Methods:
Each month, a report is generated from LINK which details every invalid dose administered. Each dose is then analyzed to ensure the accuracy of the data. NEVHC then documents the total number of invalid doses, and the number of resulting changes in the immunization schedule. A monthly report is then distributed to each site detailing each invalid dose, why it was invalid, and whether it is necessary to inform the patient of the change in the immunization schedule. The monthly report is used as an educational tool to instruct providers and staff on the immunization schedule.

Results:
In 2006, before staff education was implemented, NEVHC's average rate of invalid immunizations was 1.5%. Staff education was begun in January 2007 and continues on a monthly basis. From January to September 2007, the average rate of patients with invalid immunizations fell to 1.04%.

Conclusions:
An immunization registry can be effectively used to identify and minimize the number of invalid immunizations. Providing feedback to providers and staff is an excellent tool to increase knowledge of the immunization schedule.