Lisa Law here, I'm the physician champion for this ESCO CDC-CMSS grant project on improving vaccination rates among cancer patients. This is actually year three. Last year, we launched the flu vaccine in South Sacramento. I will give some background, followed by our nurse manager, Christy Hill, who will share and the experience, her leading effort in South Sacramento. Next slide, please. So what is Kaiser Permanente? We are one of the largest nation's nonprofit health plans, serving 12.5 million members at Kaiser. Physicians are responsible for medical decisions. Next slide. We have 12.5 million members, 40 hospitals, 618 medical offices, 24,000 physicians, 73,000 nurses and 235,000 employees. Next slide. So we are part of Kaiser Permanente Northern California. This is the service area. I am based in Roseville. This project is actually in South Sacramento, as you can see where we are at in the map. Next slide. And South Sacramento is, again, an integrated healthcare system with both primary care and multi-specialty care. There are 241 licensed beds, 30 ICU beds with more than 5,000 employees, 223 physicians with five hematologists, oncologists. We are COC accredited in terms of our population, about one-third Asian, one-third white, one-quarter Hispanic. With that, I'm going to pass on to Christy Hill, nurse manager in South Sacramento, who led the effort of flu vaccination last fall and with tremendous success. So Christy, you are on and you can share the project with all of us. Thank you. Hi, everybody. Good morning or good afternoon, depending on where you're at. Yes, I am sharing our project that was launched here last year with Dr. Law's help with South Sacramento. So basically what we looked at is the flu vaccination rates starting September 1st. South Sacramento, prior to the 90-day test of change that we did for flu, has a 13% flu vaccination rate between September 1st through December 1st. So we're looking at that as in the lower levels in comparison, especially since we have, you know, chronically ill patients and are immunocompromised. So together with Dr. Law and a team of project management that is helping us with these ASCO vaccination improvement project with Kaiser, we created a very robust 90-day process here in South Sacramento. Our SMART goal was to increase flu vaccination rates in South Sacramento Oncology Clinic and Infusion Center. So we are concentrating on the departments that I manage from 13% to 33% by December 2023. Next slide, please. So this is how we tackled it, if everybody is very curious. We did a 90-day PDSA. We divided it in three different tests of change throughout the timeframe that we're doing it. For the test of change number one, we did interventions as offering the vaccination at the registration. Any patient that agreed to receive flu vaccine at the end of their visit from RN or MA in Oncology and Infusion Clinic will be given their vaccination on site while they're at their visit. 298 vaccines we administered out of 615 in that test of change timeframe. And it's a very short timeframe. It was around 30 to 45 days and we captured that much people already. We did a training for all the staff. We also did locally in South Sacramento. We requested for one of our consultants to create us a tracking chart on Tableau, which was super helpful. What it did for us, it pulled all the patient that has visits with oncology and infusion. And with that, it showed us who has not gotten their flu shot yet for the year. So it really helped us from the beginning, identify who needs the vaccination because a lot of the times we see patients that forget about it or don't get reminded. With it having a tracking and we know that they haven't gotten it yet, it was easier for us to figure out what percentage of the patients today do we need to tackle in terms of who needs vaccination. We also created a very robust process on the oncology side. So on the oncology side, we don't have the refrigerators for the flu vaccine. So which means that, you know, in the world of PI, we all know that everything is being accounted for the waste. You know, what is the inefficiencies in that? One of our inefficiencies is that the infusion is across the hall from oncology and it's multiple steps, literally, to walk there, to get to the refrigerator, get a vaccine, come back. You know, if you time it, which I actually did, you know, from walking from our clinic to the infusion refrigerator, pulling all the supplies from there, that alone takes about 10 minutes, which you can shave off if you have all the supplies readily available on the oncology side. So what we did is that we partnered with the injection clinic and I asked them about their process because they have basically a flu center where they're just doing massive amounts of flu shots, but there's no refrigerator sitting next to the LVNs. So they have this temperature regulated ice chest, which we purchased for our side, and that's how we were able to have the vaccines readily available. That pretty much shaved off the time to get these patients vaccinated, made them less antsy to leave because we're taking too long. The vaccination pretty much took from 15 minutes to about five minutes because we have all the supplies available on our end, which really helped us out get people vaccinated more because, you know, in the essence of time, we were able to be readily available for them instead of having to walk across the hall to get the supplies. For the second test of change, we did scripting for the receptionist as well for all the patients that are sitting on the fence, not wanting to get vaccinated yet or waiting and whatnot. We also were able to acquire Spanish and Chinese handouts for people to be able to see it in a different language for those clientele. We were able to increase our vaccine administration on that time by 13.6%. We continue to track the progress with the report that we are pulling locally. And for the test of change number three, which is towards the end of our 90-day PDSA, we also asked, partnered again with the flu clinic department to send us an LVN once a week in oncology to see if they can basically have their roving cart and offer patients, even their families, a flu shot. So with that, that was not the most profitable per se on all of our tests of changes. But we've learned that the reason that was the lowest is because by the time we did that, we were towards the tail end and a lot of the patients were already vaccinated. And we were able to prove that because we are tracking the report. The report shows that, you know, in the beginning when we were at test of change one, you'll see in the report that about 90% of the patients were not vaccinated. By the time we get to the 90-day, we were seeing only about 20% patients are not vaccinated. So the lower the number, the less patients are needing to be getting the flu vaccine because they've already gotten it. So next slide. So by December 6, 2023, remember we were running this from September 1st to December 1st, South Sacramento Oncology Clinic and Infusion Center increased our flu vaccination rate to 36%. So we exceeded our goal of 33%. So we were past target. So it's showing here the map of the vaccination rates and where we were the most successful on climbing those numbers. Next slide. So just to share what the success behind our team engagement is, is that in order for you to get a team of people in the clinic that wants to embrace an initiative that's not part of their day-to-day process, we are very big on the why. We tell them why this is important, why this is good for your patients and why this is something that they should be embracing. So the why behind it is it's very convenient for your patients so they don't have to go and wait in line in the flu vaccination center. And number two, we had medical assistants that weren't trained to give immunizations before and we were able to train them and we gave them the why of this is increasing your scope of practice and also your training and your knowledge, which is good for you for experience. We leverage those educations as well. We created very defined workflows as noted from my previous slides. We created small tests of change so that we have small wins and bite-sized tests for people to be able to really accomplish. We made it convenient by making the flu vaccines available in the oncology side. We also did a friendly competition because these are sister departments. So we did a friendly competition of prizes on who can do a vaccine the most individually and against the departments. And we're also sharing weekly updates because in general, my team was just very competitive. So they like to know who's doing better and how good we're doing. Next slide. So we showcase our success. We have unit-based teams in Kaiser Permanente, which leverages frontline staff into doing PI projects to improve a lot of initiatives for patient-driven things. And because this was such a great success, we were invited to share our best practice and to share how we did this and how we accomplished such great results in such a short amount of time so that it can be spread across our medical center. So that's our process for the flu initiative here in South Sacramento. Questions? Yeah. Any questions? I love the competition because... The friendly competition. Friendly competition. I've seen it. I love that too. I've had groups who have posted it and it's been in the staff area and it becomes the highlight of the day as they give each other a hard time. Yeah. I think making it fun for the people, you'll get them a lot engaged. It's finding the fun in the project will really, really help people be more involved. Change is hard. So the more you can make it, less painful. So the handouts that you have in Chinese and Spanish, are they oncology specific or are they more generic to the flu shot? It was the ESCO handout that we pass out. Okay. Thank you. And those are our patient fact sheets, Damon. Okay. Thanks. Any thoughts as what you're going to do as you head into the next flu season, are things going to stay the same? Are you going to mix it up a bit? We're going to review it and we're going to, I think for this time around, because we don't have the timeframe, depending on when the county starts the flu season for California and Sacramento, we'll start sooner so that we can capture more patients. I will definitely continue to track the progress of this. And Dr. Law, we're even thinking about the pneumovacs, depending on if we're able to, we're working with our office of nursing and clinical practice to also offer that. It really is convenient for the patients not having to go to two departments to get vaccinations. Absolutely. Just a last word, I have to give credit to Christy, nurses know what to do the best. They know how to lead the effort. So thank you. And thank you all. Sadie, go ahead. I have a question about your tracking screen that you mentioned. Did you connect with your state immunization information registry to confirm if people were getting their flu shot at CVS or something versus in your clinic? Or how are you verifying that? No, we usually, we have in-house medical records, so that's how it's being pulled with us. And most of the time, the patients, if they said that they're vaccinated with CVS, we'll just note it on the chart that they've been vaccinated. Okay. Yeah. Okay. Any other questions? This is really, I love seeing all of this. So thank you to everyone who's presenting, because this is the fun stuff. The pictures with people, especially Bring It Alive, it's great. Assuming these are not actors, these are real people. Yeah. The girl next to me is one of my medical assistants. She actually won the challenge. She had the most vaccinations, hence she got the percent. Awesome. Good for her. Good for her. This is great. Again, we're always looking for groups who would like to share their stories on what they've been doing. So please email Sarah, myself, tell your society leads if you'd like to present, because I think the more we share this, the more we learn, which is great. And also it just, you move the needle and sometimes you can really move it in a meaningful way with just some small changes. And so this is a great example of that. Thank you. Okay.

Dr. Lisa Law

vaccination rates

South Sacramento

flu vaccination

teamwork