Increasing Maternal Influenza and Tdap Vaccination Helen Medlin BSN RN Florida Department of Health Brevard County
Objectives: • Review the Advisory Committee on Immunization Practices (ACIP) recommendations for maternal influenza and Tdap vaccines. • DOH Brevard Quality Improvement proj ects aimed at increasing the Influenza and Tdap vaccinat ion in the maternal population of Brevard County. • Premise on which we based our actions. • Actions taken to improve vaccination rates. • Results and conclusions. 2
ACIP Influenza Recommendations: Influenza Vaccine: zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA • Recommended for pregnant women at any point in the pregnancy. • When the vaccine is first available. • If pregnant in two influenza seasons to receive both seasonal influenza vaccines. 3
ACIP Tdap Recommendations zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Tdap Vaccine: • 2011 booster in pregnancy if no adult booster received. • 2012 every pregnancy between 27-36 weeks irrespective of the prior history. 4
Quality Improvement Projects zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA • 2013-2014 Increasing Influenza Vaccinat ion in the Maternal Population of Brevard County. • 2015 Increasing Influenza and Tdap vaccinat ion in the Maternal Population of Brevard County. 5
Where w e started • 2012-2013 we gave 15 doses of Influenza vaccine to our maternity clients. • 2014 we gave 75 doses of Tdap to our maternity clients. • Did not have numbers for the private practices. 6
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Premise S tudies consistently show that clients are more likely to receive vaccines if their primary care provider recommends the vaccines and there is easy access to vaccination. (CDC) 7
Approaches • Beliefs and practices • Education • Partnering with community providers • Vaccine accessibility • Improvement of documentation • Education resources. 8
Beliefs and Practices • S taff survey 2013-2014 • Follow up survey 2014-2015. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA • Addressed barriers to immunization in staff. • Provided education. • Promotion of influenza vaccine at beginning of season. • Offered staff vaccinat ion at meetings and through the clinics. • Monitor success in increasing staff vaccinat ion rates. 9
Education Increase understanding of influenza and Tdap vaccines: • S afety and efficacy. • Influenza disease and its effects on pregnant women and unborn child. • Concept of cocooning. people who can 't be vaccinated ERADICATING AN INFECTIOUS DISEASE CAN ONLY HAPPEN IF EVERYONE IS PROTECTED FROM IT ....... Ga,~,-~lit•Ut>•1,t!Alr'f"I,;, zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA l'FS 1na-ndao1 ~.rc,r.r,,c11t E"l<Joln:•- ..._.,_w,:r,• MEDICINEWISE "'-"tr" 10
Partner w ith Community Providers S urveyed local OBGYN doctors representing each practice zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA regarding vaccinat ion recommendation, barriers and challengers: • Vaccines recommended but not offered at practice. • Limited knowledge of places to refer clients for vaccines. • Cost of vaccinat ion, lack of insurance coverage. • Clients fears, misinformat ion, inconvenience. 11
Partner w ith Community Providers • Have all private providers recommended influenza and Tdap vaccines to clients. • Utilize DOH Brevard Immunization nurse as a resource for zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA vaccine hesitant clients. • Accessibility of vaccines through the DOH Brevard clinic sites. Created a flyer for private practices. • Created a resource: community providers and pharmacist s who vaccinate pregnant women. • Partnered with Healthy S tart for early education of pregnant women. 12
Vaccine Accessibility • DOH maternity clients offered vaccines during perinatal visit. • Three clinic sites offer vaccine to pregnant women and their zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA families on a walk in basis, no appointment necessary. • Free Tdap for underinsured through program 17. • Addition of program 17 influenza. 13
Improvement of Documentation • Immunization Policy and Procedure changed to reflect practice of immunizing pregnant women. • DOH Brevard IPO was updated to include the practice of zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA offering vaccines to maternity clients. • Developed clear documentation of vaccinat ion offered, declined accepted, • Document vaccinat ion in Florida S hots. 14
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Education Resources Prenatal package contains information about the Tdap and Influenza vaccines in pregnancy. Created DOH Brevard brochures for “ Pregnancy and Influenza” and “ Pregnancy and Tdap Vaccine” CDC flyers distributed to all DOH clinics and private OBGYN practices. 16
Where can I go for more Information? FLORIDA DEPAR T MENT O F Pregnancy HEA LTH IN BREVARD COUNTY P regnancy an d Whoopi ng Cough and www.cdc.go v/ pertussis/ pregnant Mlulon Im mu n izations f or Wome n The Tdap Vaccine www.im mu ni za ti on forwo me11.mg/ To protect, promote. and Improve the health of imm uniz at ion_ fac ts /v accine- all people in Fl-orlda ,through integrnted state, p.revent aMe _dis ea ses/ pertu ssis county and community efforts. Va oo' nes du ri ng Pregna n cy Visio n www. mi c:iwiife . orgl omot-vacci 11e s- du ni ng- To be the l'lealth l est state in the nation. pr eg11an cy YII ues ; ( IOARE) Am erica n Academy of fami ly ! Physicians www. aa fp.or g/patient-care /immu ni za ti ons/ Innovation: We search for creative solu tJ ions disease-popul latio n. MmI I and manage resources wisely. . Tdap \laod i ne l l nforma t lon Statement (VIS): Collaborati on : We use teamwork to achieve www . cc:ic .gov /v aoc,i 11e s/ lt mp / vis/ vis- common goals & s-o l ve •problems. s tatement s/ tdap . llt mI Ac countability: We •perform wi th integrity andi respect. Responsiveness: We achieve our mi ss ion by serving our customers & engaging our partners. Ex cellence. We promote qua.li ty outcomes through learning & continuous performance improv ment. Ask your provider about getting the H ID -24 0E (09- 15 ) Tdap Vaccine during FLORIDA DEPARTMENT your third trimester ori da Oe1>1rtme n t of F l H ealth in , Brevard County OF HEALTH 2575 N. Courtney ~ rnway Me rri tt Island, FL 32953 IN BREVARD COUNTY 32 1-637- 7300 www.floridaheal th .gov B evard County
TDAP S THE BEST G VE DON' FACTS PROTECT ON FOR PERTUSS S TO + Pe rtussis (wl hooping cough) is YOUR BABY YOUR BABY- a respi ra tory tract i nfect ion. GET VACCINATED + Pe rtussis is s1 imi l ! ar to a common col ld except tl he cou gh progresses int o an Pertussis symptoms include: intense cough t: hat can l l ast fo r + Nasal l congesti on several ! mi nut es. + Feve r + Pe rtussis can be a deadly + Sneezing infection to NEWBORNS. Milld cou gh • + Si ne e 2010 app rox imatelly 10 + The cough can progress into to 20 babies have d·ed per The Tdap Vaccine an intense cough th at can year due to Pe rt ussis. last for several m·n ut es. + Newborns do not receive the ir • Tdap is an injection. fi rst vacci n at i ions u nt il l they are • Tdap is recommend for two months olld. pregnant wom en b et ween + Mothers can pro v1 id e immun1 ity 27- 36 weeks. to her ch ild by receiving the • Research has sl hown it is safe T dap vaccinat ion wh en she is during pregnanc y. 27 to 36 weeks pregna nt . • Women can still breastfeed af ter vaccinat ion.
Monitoring Success and Failures • Measuring impact on private providers and their clients was difficult. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA • Utilized the HMS system to monitor the impact on DOH Brevard perinatal clients and DOH Brevard S taff. • Audited client files to assess success in increasing the clients offered vaccinat ion. 19
Influenza Dose . s Adm·nistered to Maternity Clients 243 164 .. ··. 66 • ·. 15 12-13 13 - 14 14-15 , 15 -· 16 16-17 17-18 IN FLUENZA SEASON
Td ap Dos , es A, red to I dmin 1 ste 1 Mate11nity C l ients 1 %, Maternity Clients 460 408 59% 275 33% 75 2014 2CJi15 2017
BREVARD CO NTY PERT SSIS CASES INC ILDREN N E · 1 YEA · 0 AGE. 4 . 3 2 2 1 2010 2011 2012 2013 2014 2015 .2016 .2017
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