Bismarck-Burleigh Public Health (BBPH) participated in a national quality improvement project that was guided by the National Improvement Partnership Network (NIPN), Academic Pediatric Association (APA), and the Continuity Research Project (CORNET) for the Cohort 3 project time period from January, 2017 through October, 2017 in an effort to increase Human papillomavirus (HPV) vaccination rates and reduce missed opportunities of the HPV vaccine. Monthly data collection through BBPH's electronic health record (EHR) system was completed by project members. Subsequently, project members ran data reports from the North Dakota Immunization Information System (NDIIS) for adolescents aged 11-13 years that were due to receive the HPV vaccine. The NDIIS was also utilized daily as an access point for provider-prompts that were assessed for every adolescent aged 11-17 years that had an appointment at BBPH. Reminder-recall letters with best-practice education were mailed to several hundred adolescents to promote community education of the HPV vaccine and a prompt parents and guardians to obtain the vaccine for their children.
Keywords: HPV vaccine, reminder-recall, provider-prompt
https://www.bismarcknd.gov/95/Public-Health
The City of Bismarck and Burleigh County are continuously experiencing growth and the effects of an increasing population. The estimated population of Burleigh County as of June 1, 2018 is 96,990 which is a .32% increase from July 1, 2017 (96,684) and an increase of 19% from the 2010 US Census Bureau population of 81,308. The Estimated population of the City of Bismarck as of June 1, 2018 is 74,391 an increase of .45% from July 1, 2017 (74,060) and an increase of 21% from the 2010 US Census Bureau estimated population of 61,272. With this increasing population and change in demographics, public health services are in high demand.
A total of six BBPH staff were involved in the Cohort 3 practice project and took part in monthly data collection, webinars, and practice project requirements. Overall, five registered nurses and one office manager made up Cohort 3 practice project team and directed several activity strategies that were subsequently implemented into practice at BBPH. All registered nurses employed at BBPH were made aware of the practice project as well as office staff to ensure buy-in of the project and a universal understanding of the implementation strategies.
The first strategy that was implemented as part of the Cohort 3 practice project was a provider-prompt system. Front office staff would pull a list of client's that were on the schedule to be seen in the clinic on a daily basis. Then, they would access each client's immunization record from the NDIIS and print a copy for a registered nurse to review. Every adolescent aged 11-17 years was assessed for HPV vaccination status at every clinic visit, even if they were not scheduled to receive immunizations. If the client was eligible to receive HPV vaccine, it was offered by registered nurses and documented in the electronic health record.
Custom fields were developed in the EHR to document the following information at every adolescent visit: HPV eligibility status, provider-prompt utilization, previous doses of HPV given, if HPV was given at date of service, and a reason for not administering HPV vaccine. A monthly report was completed and assessed for any failure to comply with HPV custom field EHR documentation. If documentation was not completed, staff were consulted for reasoning and reminders were sent to ensure future compliance was garnered.
An additional strategy of reminder-recall was implemented as a way to both communicate with the public about the HPV vaccine, and prompt parents and guardians to obtain the HPV vaccine for their children. At the start of the Cohort 3 practice project, team members completed an extensive assessment of all adolescents that were assigned to BBPH in the NDIIS and were due to receive HPV vaccine. Letters detailing the importance of the HPV vaccine and an explanation of why and when it is needed were sent to all eligible adolescents. Documentation of these activities was also completed in each client's chart in BBPH's EHR. By documenting that reminder-recall letters were mailed, BBPH could track if the letters were successful in improving vaccination rates.
Cohort 3 practice project team members received valuable education from partners at NIPN, APA, and CORNET through monthly webinars. Webinar topics ranged from quality improvement, improving provider recommendations, and reducing missed opportunities, to specific HPV vaccine information, and office policies management. Practice project team members found the education surrounding difficult parents or guardians showing resistance to the HPV vaccine the most helpful throughout the webinar series'. The most common reason for clients not receiving the HPV vaccine at BBPH is due to parental/guardian resistance and refusal.
Model Practice Program: Bismarck-Burleigh Public Health
City of Bismarck
Bismarck, ND 58504
Director: Renae Moch, MBA, FACMPE
Project Lead: Theresa Schmidt, RN, BSN
Application Author: Betsy Kanz, RN, BSN
Bismarck-Burleigh Public Health Director
Renae Moch, MBA, FACMPE
rmoch@bismarcknd.gov
(701) 355-1541
Bismarck-Burleigh Public Health Nurse Manager
Theresa Schmidt, RN, BSN
tschmidt@bismarcknd.gov
(701) 355-1578