AVAC Spotlight: Utilizing Standing Orders to Generate System Change
The Ochsner Health System is Louisiana’s largest health system, comprising more than 80 health centers and urgent care centers, 29 hospitals, 18,000 employees, and more than 1,100 physicians covering 90+ medical specialties and subspecialties. Ochsner created a System Vaccine Subcommittee, a group of providers, pharmacists, nurses, IT specialists, inventory management, and nurses to increase immunizations for their patients. The team is led by Dr. Katherine Baumgarten, medical director of Infectious Disease and Dr. April Green, ambulatory care clinical pharmacist for population health. Together, they worked to implement written order guidelines, also known as standing orders, which are approved by a physician or other authorized practitioner that allow qualified health care professionals eligible under state law (such as registered nurses or pharmacists) to assess the need for and administer vaccines to patients meeting certain criteria, such as age or underlying medical condition.
By centralizing the system, Ochsner identified immunization challenges and implemented a plan to resolve them while communicating and disseminating critical information to the community. The committee targeted five immunizations: influenza, pneumonia, Tdap/Td, zoster, and HPV. Ochsner has routinely developed internal and external partnership opportunities – teaming up with Louisiana LINKS to improve data sharing between the state vaccine registry and Ochsner’s Electronic Health Record (EHR); collaboration with drug manufacturers to get education to staff; and support from the American Cancer Society on HPV education for staff. With their EHR team, they also created registries to identify patients in need of immunizations and updated their EHR health maintenance screen to communicate care gaps to providers and staff. With the newly created quality metric immunization dashboard in the EHR, they can communicate immunization rates for each provider, all of their clinics and the entire system across all five targeted vaccines. Lastly, partnering with their nine retail pharmacies to help increase adult immunization rates has also been critical to their success. The creation of a new order mode in their EHR to allow retail pharmacists to administer all vaccines allowed by Louisiana law has expanded their vaccination reach throughout the System tremendously.
The biggest game-changer has been giving the nurses the ability to engage in vaccine assessment and administration for all patients. To ensure nurses are prepared and up to date on their vaccine information, a series of system-wide educational sessions were conducted during National Immunization Awareness month in August. More than 130 nurses, providers and pharmacists were educated on ACIP recommendations for adult immunizations. The data show that the steps Ochsner has taken to increase adult vaccination rates are working. Employee influenza vaccination rates were 97.5 percent and 96.4 percent, respectively, the past two years. They are meeting the Healthy People 2020 goal of 30 percent immunization rate for herpes zoster in adults ages 60 years and older.
The Ochsner team aims to further advance this work. One idea on the horizon is creating a system that more easily identifies locations where immunizations can be provided in clinical and pharmacy settings. Green notes that any new steps will be built on the importance of putting patients first to prevent disease—the foundation for success within the Ochsner Health System and for the System Vaccine Subcommittee. With dedicated professionals working hard to improve patient care, Ochsner’s commitment to serve, heal, lead, educate, and innovate will continue to be in good hands.