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Improving School-based Immunization Using Individual Consent Forms
‘Pilot’ study
Brett Hodson, ManagerPublic Health Services
Island HealthNovember 24, 2015
Acknowledgements
Comox Valley Team• Cheryl Viel – PHN, School Lead• Amber Thomas – PHN, School Lead• Shelly Lesperance-Farndon – Admin Lead• Jenny Nijhoff – PHN Coordinator• Donna McNeil – Immunization Coordinator• Immunizing Nurses, Volunteers, School PartnersThanks to:• Penelope Nica, Panorama Central Support Team
Purpose of the Project
• Proof of concept using Panorama as the information system supporting the practice of using mass functionality and individualized consent forms– Determine utility of system tools and workflow
• Determine implications of completely catching up immunization status of grade 9 students based on history
Tests
• Introduce consent form to parents and get feedback on utility, improvements, and make changes
• Implement the Panorama ‘Cohort Management’ and ‘Mass’ functionality at all health units (including pilot site)
• Implement documented individualized consent workflow, tools, and forms at three schools in the Comox Valley.
• Implement changes to workflow and tools based on experiences
Measures
• Reduce nursing time receiving phone calls about the form and immunization history
• Reduce nursing time making calls due to incorrectly/incompletely completed consent forms
• Reduced nursing time entering consent and immunization information
• Reduce number of booked appointments at health unit of grade 9 students
• Increase in number of grade 9 students fully immunized
Balancing Measures
• Increase in admin time to prepare consent packages• Satisfaction with using the Panorama tools and the
workflow to immunize students• Satisfaction of parents and students of
immunization experience• Increase in ‘bum in the chair’ for Gr. 9 students
being caught up• Nursing time conducting follow up visits at schools
to complete series
Parent Feedback about Consent Form
From Parents review:• Easy to understand• Parent likely won’t have client held record to
verify accuracy of consent form• Text was too small, increase white space• Preference for order of vaccines chronologically
rather than alphabetically (so it matched historical recollection or hard copy records).
School Sites
• School ‘A’ - K to gr. 7, primarily serves military families, 19 number of gr 6 students (control 16 students)
• School ‘B’ - K to gr. 7, semi-rural catchment, 47 number of grade 6 students (control 48 students)
• School ‘C’ - Gr. 8 to 12 school ‘C’, 106 number of grade 9 students rural/urban catchment (control 75 students)
Percent of Outgoing Calls by Nurses to Gr. 6 Test and Control Schools Student by Reason
Reason for Outgoing Call
% o
f Stu
dent
s
Percent of Outgoing Calls by Nurses to Gr. 9 Test and Control Schools Student by Reason
% o
f Stu
dent
s
Reason for Outgoing Call
Nursing related Findings Schools A and B
• Change management requirements under-estimated
• Workflow and tools modeled after PARIS/VCH • Worksheet inadequate, poorly designed for
purpose(s) and nurses did not trust info• Unrelated confounders (nurses perception of
time and use of volunteers)
Nursing Findings: Schools A and B
• Challenges in using documented workflow and tools– Batch and re-batch forms to enter consent by one person– Manual verification consent forms to mass imms against
worksheet– Manually highlighting mass imms worksheet vaccines to
be provided (poorly designed tool)– Reprint consent forms and after care sheets for
telephone consent and to take to schools (Public Health did not receive form)
– Nurses challenged to document on worksheet
Changes for School ‘C’
• Two individuals enter consent into Mass functionality
• Abandoned worksheet, modified consent form to provide documentation tool
• Addressed confounding variables of perceptions of time and use of volunteers
• ‘over staffed’ based on unknowns
Nursing related Findings School ‘C’
• Process was smooth and efficient• Over production of consent forms and after
care reports (improve training/understanding of functionality)
• High satisfaction amoung nurses that students were caught up at school
• Two nurses immunize students being caught up was safe and effective using local workflow
Nursing related Findings School ‘C’
• Immunized 61 youth (58% of Gr. 9 students) in 60 minutes at school with:– 8 Immunizers– 1 Lead– 2 Volunteers– Vice-Principal of School
Admin Preparation Related Findings– Entry of cohorts not overly onerous, experience
doing this previously with iPHIS (however automation (e.g. STIX) would help greatly)
– 4 hours to prepare 106 consent packages for School ‘C’, completed by a volunteer. Generic consents packaged by printer, at a cost.
– Generally found running and printing consent and after care reports straight forward
– Consent form missing data (school name, forecasted vaccines for telephone consent section)
Next Steps
Conduct a detailed debriefing and make recommendations• Identify areas for improvement in Panorama
functionality and share with PCST• Preliminary suggestion is to expand personalized
consents to all schools (at least in Comox Valley), and to immunize Gr. 6 and Gr. 9 students based on history.
• Plan second visit to Gr. 9 school• Monitor other indicators
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