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Background

The Advisory Committee on Immunization Practices (ACIP) and the Center for Disease Control and Prevention (CDC) have published recommendations and guidelines regarding routine vaccinations

Reporting at Parkland Health and Hospital System (PHHS) has revealed a consistent number of vaccine related safety events despite previous quality improvement projects

Aim

To characterize the nature of immunization related reports that occurred in Parkland’s Community Oriented Primary Care Clinics (COPC) in order to identify the most common contributing factors. Additionally, further strategies will be developed to aid in the mitigation of vaccine related events

Methods

Retrospective chart-review study, conducted at PHHS’s low-income urban outpatient care clinics

Evaluation of Immunization-Related Safety Reports in

Low-Income Urban Outpatient Care Clinics

Hope Askew, PharmD¹, Cortny Anderson, PharmD, BCPS¹,

Talemah Jones, MS, PharmD¹, Rusty Appleberry-Recker, PharmD¹

¹Parkland Health & Hospital System

Results

Next Steps

Develop a stream-lined approach for vaccine documentation and administration
Adjust workflow to decrease the potential for vaccine errors regarding documentation and administration
Implement strategies to further optimize the EHR system to aid in correct vaccine selection and administration

Conclusions

93% of all vaccine related events were attributed to failure to assess the electronic health record (EHR)

Over the last 5 years, vaccine related events at PHHS have remained steady despite various quality improvement projects and education sessions. This demonstrates a need for alternative workflow interventions and EHR optimizations

Study Limitations:

Retrospective study design
Inability of EHR system to display immunization records on the patients Medication Administration Record (MAR)
Incomplete or indeterminable data
Relying on events to be reported, total number of events may be more than what is displayed

References

Immunization schedules. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/index.html. Published August 23, 2021.
Sarah E. Brewer, Juliana Barnard, Jennifer Pyrzanowski, Sean T. O'Leary, Amanda F. Dempsey. Use of Electronic Health Records to Improve Maternal Vaccination. Women's Health Issues. Volume 29, Issue 4, 2019, Pages 341-348,https://doi.org/10.1016/j.whi.2019.04.017.

Vaccine related safety events voluntarily reported between January 2016 through October 2021

Inclusion Criteria

Non-vaccine related safety events reported voluntarily at Parkland Health & Hospital System
Duplicate reported vaccine related events that were submitted for the same patient and same event

Exclusion Criteria

The frequency of the primary cause for the immunization-related safety event

Primary Outcome

Rate of vaccine related safety events that occurred in:

Different Vaccines
Different age groups
Ordering provider title
Administering provider's title

Total number of events every year from 2016 to 2021

Secondary Outcomes

	N=90
Age Group (%) Birth-15 Months 18 Months-18 years 19 years - 64 years >/= 65 years Unknown	20% 20% 48% 9% 3%
Gender (%) Female Male	71% 29%
Clinical Service Location Where Event Occurred (%) Adult Gynecology HOMES Obstetrics Pediatrics Unknown/Other	22% 10% 4% 21% 40% 3%
New or Existing PHHS Patient (%) Never previously seen <12 months since last visit >12 months since last visit Unknown	10% 79% 6% 5%

Disclosure: All of the authors have nothing to disclose concerning possible financial or personal relationships with commercial entities

Table 1. Baseline Characteristics

Graph 1. Ordering Provider Associated with Vaccine Related Safety Event

Graph 2. Administering Provider Associated with Vaccine Related Safety Event

Graph 3. Primary Outcome (N=90)

Graph 4. Total Number of Events (N=90)

Graph 5. Percentage of each Vaccine per Reported Safety Event (N=90)