Summary of abstract presented at the 1999 Annual Meeting of the Ambulatory Pediatric Association

Immunization Entry at the Point of Service Improves Quality, Saves Time, and Is Well Accepted. Adams, WG, Conner, W, Mann, A, Palfrey, S. Boston University School of Medicine, Boston, MA.

Objective: Computer-based immunization tracking is a routine part of many pediatric practices; however, data quality is inconsistent and entry often relies on dedicated data entry personnel and is time consuming, expensive or difficult. The purpose of this study was to evaluate data quality, nursing satisfaction, and reduction in documentation burden following the introduction of a point of service immunization entry system in an inner-city pediatric primary care center.

Design: Prospective pre- and post-intervention study.

Methods: Visit records from all pediatric non-urgent care visits for patients <5 years old were collected during a 2-week period before (pre-intervention) and after (post-intervention) the introduction of a computer-based immunization entry system. Nurses used software designed to allow rapid entry during immunization preparation followed by printing of two adhesive labels for documentation. Satisfaction was evaluated using an 8-question survey administered 3 months after the intervention.

Results: One hundred forty-seven (63.6%) of 231 pre-intervention and 132 (51%) of 257 post-intervention children received at least one immunization (immunized) during the study visit. Gender and mean age were similar for immunized children in the two groups. In the pre-intervention group, 56 (37.9%) of 147 immunized children had at least one dose missing (a total of 128 of 343 doses administered) from the immunization tracking database compared with none in the post-intervention group. Medical record review showed that 92.6% of pre- and 91.4% of post-intervention children were on-schedule after the study visit. However, missing data lead to the misclassification of pre-intervention children - only 68.4% were reported by the database to be on-schedule (p < 0.001). All of the nine nurses reported using the program "all the time" to enter immunizations, 89% said that the program required "somewhat" or "a lot" less time, and 100% strongly recommended continued use of the program. All nine nurses also reported that they would be "somewhat" or "very" unenthusiastic about the system if labels were not available. During the 12 months following introduction of the system, 8273 forms containing immunization information were printed, preventing nurses from having to write over 101,000 dates.

Conclusions: Immunization entry by nurses at the time of immunization preparation improves the quality of tracking data, reduces misclassification of immunization needs, saves time, and can be well accepted. It is likely that poor data quality in some tracking systems has led to falsely low immunization coverage estimates. Systems such as the one in this study can improve quality and should be integrated into routine clinical practice.