Facilities Involved in Vaccinations QIA
IPRO ESRD Networks will be implementing CMS designated activities with facilities chosen for this activity to increase rates of pneumococcal pneumonia and hepatitis B vaccinations at the facility level. Facilities will be provided with root cause analysis (RCA) templates that the Network will review with the project lead to develop a Plan Do Study Act (PDSA) Plan for improving rates of pneumococcal pneumonia and hepatitis B vaccinations. The project will be conducted beginning in April 2016, and will end September 2016. Facilities must increase their vaccination rate by a minimum of two percent for both vaccinations by September 2016 and facilities that do not meet the vaccination rate >60% will continue into the project for the next calendar year (2017).
- The Network will provide a notice of participation in this activity, as well as a template for evaluating the root cause analysis of low vaccination rates for pneumococcal pneumonia and hepatitis B
- Facilities will use the provided RCA template to review both vaccination rates with the interdisciplinary team during QAPI meetings and return it by April 15, 2016. The Network will conduct a webinar at the end of April to (1) Review the RCA findings and to (2) discuss identified interventions related to the RCA.
May – September 2016
- Facilities implement interventions and provide a summary report to the Network on a monthly basis by email or fax of any key observations discussed during monthly QAPI