Quality Improvement in a Large Immunization Registry

Background:
Quality improvement in immunization programs is important regardless of the numbers of providers and numbers of patients seen.

Setting:
The Kaiser Permanente Immunization Tracking System (KITS) Management Team has been stressing quality since 1993, when the system was implemented in 12 Southern California Medical Center Areas.

Population:
Over 3 million members, and 30 Million immunizations. However, the methods tested here will apply equally to small practices.

Project Description:
To monitor, update, and improve immunization practice, tested quality assurance measures are used. Immunization Coordinators at each medical center are responsible for presenting in-services, monitoring quality, and coaching nurses and physicians who have problems and/or omissions in their immunization practices.
Data quality measures include routine automated data analysis and special analysis carried out by immunization coordinators at medical center and office practice levels. In addition, beginning in 2007, a concerted effort was made to improve the recording of Manufacturer/Lot Numbers in KITS. This included finding expired lot numbers, lot numbers whose “masks” do not match appropriate manufacturers, and lot numbers which were not changed in KITS when a new batch of vaccine was used. Beginning in November, 2007, all medical centers and clinics were required to carry out daily reports and monthly audits of all refrigerators to ascertain if the correct data had been entered into KITS. If a medical center reached 100% compliance for three months, no audits were necessary for three months. If they did not, a remediation plan was required.

Results/Lessons Learned:
In November 2007, one medical center area had 100% compliance. By July 2008, three were on track, and by November 2008, six had 100%. Five others were above 90%. One has been in compliance consistently throughout the period. Routine quality monitoring helps produce excellence in immunization services, which can be applied to practices of any size.