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Story of Measurable Improvement in Public Health


 
 
Name of Health Department/Agency: Kane County Health Department
State: IL
Contact Name: Claire Dobbins
Contact Information: dobbinsclaire@co.kane.il.us
Date Added: 9/26/2011
Program/Topic Area: Immunizations, Public Health Nursing
QI techniques/tools:  Fishbone Diagram, Flowchart, Force-field analysis, PDCA, Run Chart,
Description of the process and intervention: The goal of this project was to increase the percentage of Public Health Nurses who had reached a level of "Competent" (as defined by the Benner Stages of Clinical Competence Model) with regard to administration of childhood vaccination. Prior to a reorganization of the agency, only a limited number of nurses worked with immunizations. Baseline data indicated that only 25% of the nurses had reached this level, and only 54% were receiving mentoring from an expert. The Aim Statement was that by July 2011, 100% of nurses would be deemed "Competent." Root cause analysis indicated that lack of opportunity (infrequent, small clinics), lack of specific training plans, and lack of access to an expert were prohibiting advancement in competency. For the intervention, the Public Health Nursing group drew from experiences in H1N1 response, creating a modified version of the POD system where an expert, a Novice and an Advanced Beginner worked collaboratively. Pre-screening/chart review was done prior to clinics (which were fully booked) by those working in the clinic, so that efforts in the clinic could focus on vaccine administration without added pressure of reviewing charts. In addition, nurses were given opportunity to participate in additional clinics outside of the department.
Result/outcome: Within 5 months of implementing these interventions, the percentage of Public Health Nurses who had reached a level of Competent (Benner Model) increased from the baseline of 25% to 93.33%. All but one nurse had been deemed "Competent" by the Public Health Nursing Supervisor, and specific plans were made to assure that nurse was deemed "Competent." In addition, each Public Health Nurse self-evaluated their skills and was in agreement of the level determined by the Supervisor. As a result of this process, all new-hire Public Health Nurses will use this model when undergoing training, and a modified version of this POD system (an expert is on site for technical assistance, but also provides services) has been implemented with demonstrated success.
Next Steps: The Public Health Nursing section is working to sustain the gains demonstrated through this process. Each nurse now designates how often she wants to participate in clinics, with the expectation that she participates in enough to keep skills current. Supervisory staff and/or Experts (as described by Benner) continue to monitor and evaluate the skills of each nurse, and will work collaboratively if it is noted that skills are no longer meeting the level of Competent.


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