Improving pneumococcal and influenza vaccination rates for patients with COPD

Overview

What is the aim of this QI activity?

• Improve vaccination coverage for vaccine-preventable respiratory illnesses for our patients with COPD.

• Identify and recall 10 patients with COPD that are due an influenza and/or a pneumococcal vaccination.

What will I need to do?

• Use Primary Sense reports to identify 10 patients with COPD that are due for an influenza and/or a pneumococcal vaccination.

• Review immunisation history on Australian Immunisation Register (AIR)

• Contact the patient to arrange an appointment.

• Document immunisation information.

How will I complete this activity?

Identify who in the practice will search for eligible patients, check immunisation history, administer the immunisation, who will document and track the results. Use the step-by-step guide below to assist.

Where do I document my results?

• QI summary register

• PDSA template

• Influenza and target posters

• Pneumococcal target posters

Who can I contact for support?

For support with this activity, please contact the General Practice Quality Improvement team on Ph. 38647540 or email: support@bsphn.org.au

1. Identify patients with COPD

Using Primary Sense, identify 10 patients with COPD that have clinical records indicating they are due for an influenza and/or pneumococcal vaccination. To do this, we suggest using the Chronic Lung Disease and Asthma report and reviewing patients booked in with missing PIP QI measures.

Chronic Lung Disease and Asthma report

• Using the search function, search for COPD or Chronic Obstructive Pulmonary Disease (depending on how your practice codes the condition). This will filter the report to those patients with a COPD diagnosis coded in their patient record.

• The columns titled “History of Pneumococcal Vaccination” and “History of Fluvax” can then be used to identify patients that have do not have a current influenza vaccination and/or pneumococcal vaccination recorded in their clinical record. The arrows beside the columns can be used to filter by date. 

Patients booked in with missing PIP QI measures 

• Column titled “FluVax due reason(s)” can be used to identify patients with COPD, diabetes and/or over 65 years that have an appointment in the next 2 weeks and do not have a current influenza vaccination (<15 months) recorded in their patient record.

• To filter the report to patients with COPD, use the search function to search for COPD or Chronic Obstructive Pulmonary Disease (depending on how your practice codes the condition).

• Tip: the Primary Sense report can be extracted for ease of use and saved as an excel file.

2. Review patient immunisation history

For the 10 patients identified in step 1, use your clinical software to access the Australian Immunisation Register (AIR) and view their AIR immunisation history. If applicable, save any missing vaccination record entries from AIR into the patient’s clinical record at your practice. 

For MedicalDirector, right click on the vaccination record you wish to save and select “Store Locally”

For Best Practice, right click on the vaccination record you wish to save and select “Save to patient record”.

3. Contact your patients

Once immunisation history from AIR has been reviewed and patient records updated. Recall and/or set-up a reminder for 10 of your patients with COPD that are due an influenza and/or pneumococcal vaccination.

Potential ideas for recalling patients:

• Phone the patient

• Send an SMS reminder to the patient

• Create an internal prompt in the practice clinical software for patients with appointments coming up in the next two weeks (the Primary Sense report can assist with this).

4. Document patient vaccinations

Prior to administering any vaccines provide patient with the Table. Pre-vaccination screening checklist | The Australian Immunisation Handbook.

After the vaccination has been administered, ensure this is documented in the immunisation section of the patient's file.

• Record an immunisation in Best Practice - refer to instructions Record immunisations

• Record an immunisation in MedicalDirector - refer to instructions MD Help.

Update recall/reminder system if future vaccinations are required.

5. Document Results

Document results of the activity. You can use the tracking posters to record results and display them in the treatment room or lunch room so that team members can see the impact of their changes. You can also document your results in the QI summary register or MFI/PDSA.

Tracking results

This section will assist you to track your results and answer the following questions:

• How will you know that change is an improvement? 

• What data will be used to track the improvement? 

• What is the current data showing?

Suggested measures and data sources

• Use the Primary Sense desktop report “PIP QI report – 10 measures’’ to record “QIM 6 – Patients with COPD who have been immunised against influenza”. The numerator for QIM 6 can be used pre and post activity for a comparison of the number of patients with COPD and a current influenza vaccination (<15 months) before the activity and after the activity.

• Manually record the number of patients identified, recalled and provided an influenza and/or pneumococcal vaccination from the QI activity. 

How did you go?

As a team, reflect on how the activity went.

• What were the challenges/barriers?

• What worked well?

• Are there any small changes that you could implement to continue improving vaccination coverage for your patients with COPD?

Share your results

Share your results with your team and Brisbane South PHN.

Need support?

Consider if there are additional patients with COPD you can contact to update their vaccination or consider another activity.

QI activity example

View the Model For Improvement (MFI) diagram and Plan, Do, Study, Act (PDSA) example of a practise aiming to increase their number of active patients with COPD who have an influenza vaccine.

COPD and influenza vaccination MFI & PDSA example.