Chris Kjolhede, MD, MPH Attending Pediatrician Bassett Healthcare Medical Center. Tdap for Dads

Transcription

1 Chris Kjolhede, MD, MPH Attending Pediatrician Bassett Healthcare Medical Center I have no conflict of interest I have received no payment for this work/this presentation (though I do get lunch). 1

2 Pertussis/whooping cough (you know the drill) Tdap: two forms licensed for dads Pertussis in infants Bad outcomes 50% < 1 year old who contract pertussis are hospitalized 2/3 who are hospitalized have apnea 16%di 1.6% die Cocooning Recommended by ACIP since 2005 (but no conclusive evidence) Transplacental maternal antibodies Vaccinating all close contacts, dads, etc. Bassett Healthcare Network 2

3 What s the risk for NOT covering dads, for not cocooning? What s the cost for NOT cocooning, the cost for an infant with pertussis? Pediatric Critical Care in the ED at Bassett $1000 to get into a room $1322 for the 1 st hour $650 for each additional ½ hour Transport with O2 and monitoring to AMC $650 for the ambulance $13.50 per mile for the care ER visit at AMC (pass through) $500 triage fee AMC PICU $6290 per day 3

4 Assumptions Costs averted Patient is an infant less than 4 months of age Outlying ED visit is 2 hours PICU stay is for 2 days Total costs for one infant NOT including diagnostics like x-rays and labs: $18, He s not our patient! Who will bear the risk? Bassett Barriers Who will order the shot? How do we get registration stickers? Who will pay for this? We re very busy, who s going g to do this? Who asks and consents the dad? Who signs the order? Who gives the shot? 4

5 RN and MD champions Planning Process Informally piloted the concept of Collected the suggested barriers to implementation Identified stakeholders and barrier breechers Sought administration buy-in: CNO and COO Included Chiefs of Pediatrics and Women s Health Many meetings over months Protocol, Policy, Procedure Planning Process: key meeting Stakeholders Billing department Pharmacy Nursing (both in- and out-patient representatives) Bed management (Registration) Corporate Communications Risk Management STOP! No why-we-can t comments. Tell me how! Each stakeholder found a way to overcome a barrier within their specific area. 5

6 Implementation Process Ask dad about Tdap during the admission process Give him the Dad s packet Tdap Q&A sheet and Tdap VIS sheet Confirm that dad wants to receive the vaccine Obtain Tdap documentation packet: Order and Consent form, Standing Order sheet, Tdap Protocol, Anaphylaxis protocol, Charge document Give dad the consent form: no signature, no shot Call Outpatient Billing for stickers Scan the Standing Order sheet to pharmacy for profiling Apply stickers to immunization sheet and charge document Obtain vaccine from the Pyxis (if dad is < 19 he qualifies for VFC) Confirm that dad has read and signed all appropriate documents Administer the vaccine Document the vaccine on the bottom of the consent form and make three copies C t d O d f i Consent and Order form is now an approved Bassett form to be scanned into the EMR 6

7 Early results Number of births since starting this initiative (10/8/2012) at Bassett Birthing Center: 302 Number of Tdaps given to dads: 82 Dads covered by our initiative alone: 27% Some issues identified When the Birthing Center is busy, dads may get missed EPIC (EMR) go-live happened at the same time we initiated this effort Out-of-pocket costs are not insignificant ($103) No way to register refusal No way to document outside administration 7

8 : what s next? Some CQI for Tdap coverage What percent of dads got the shot? What percent got the shot from us? What were the barriers at our site? How can we do this better? How can we pay for this? : what s next? Consider bundling the cost of dad s shot with the mother/infant bill Encourage Tdap for moms AND dads during prenatal visits Consider cocooning for influenza in the season 8