UNIVERSITY 9 8 .Reference 10 9. Annex

                                                      UNIVERSITY
OF GONDAR

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING

DEPARTMENT PEDIATRIC AND CHILD HEALTH NURSING

 

Assessment of pediatric immunization service in
university of Gondar hospital

 

    

 

By:
Mekdess Wesenyeleh

     ID No: GUR/

     Email: [email protected]

Submitted
to: Mr. Amare Hailekiros(BSc, MSc)

                        Email:[email protected]

 

 

 

 

 

 

Acknowledgement

First, I would like to thank Mr Amare Hailekiros for
giving this clinical audit  project as an
assignment and for providing the course.and secondly, I would like to thank
department of pediatric and child health nursing for involving this course in
the curriculum and writing the supportive letter to the hospital.

Finally, my deepest acknowledgment goes to Mr. Workiye
Mulugeta (head nurse of pediatric unit) for helping me during the data
collection period.

  

 

 

 

 

List
of Acronyms and abbreviations
      

 

1. CI-contra indications

2. EPI-expanded program of immunization

3. FMOH-federal minister of health

4. WHO-world health organization

5. VPD- vaccine preventable disease

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table
of contents

 

Contents
Acknowledgement ii
List of Acronyms and abbreviations  iii
Table of contents  iv
List of tables and figures  v
1. BACKROUND/RATIONAL  1
2.AIM AND OBJECTIVES  2
3.Audit methodology  4
Audit population  4
Audit sample  4
Data collection method  4
Data collection period  4
Data analysis  4
4. Discussion  7
5. Conclusion  8
6. Recommendations  9
7. Action plan  9
8 .Reference  10
9. Annex  11
 

 

 

 

 

List
of tables and figures

Table- 1 Audit standards table for pediatric
immunization service in UOGH

Table 2: Audit Result

Table 3: Audit Performa used for data collection

Figure 1; percentage of parents educated about
immunization during data collection

 

 

 

 

1.
BACKROUND/RATIONAL

Infant mortality rate and under five mortality rate
is highest in Ethiopia. Vaccine preventable disease, malnutrition and diarrheal
disease are the major causes for childhood death in Ethiopia and other
developing country. ()

Immunization is indisputably one of the most cost
effective and lifesaving intervention to protect children from VPD (vaccine
preventable disease).(EPI BASELINE)

The expanded program of immunization
started in Ethiopia in 1980 by Ethiopian federal minister of health (FMoH) with
the intension of increasing the immunization coverage by 10% annually and reach
100% coverage 1990.to achieve the goal, the Ethiopian FMoH developed strategies
and schedule for providing vaccines to the under one year children based on the
recommendation of WHO. Despite the huge effort made over decades by federal
ministry of health along with WHO, UNICEF and other partners, the expansion of
the immunization service fell short of the target set for 1990. According to recent EPI review,
conducted in 2001, restraints of the program are lack of supervision, high
drop-out rates, inadequate number of trained health workers and inadequate
supplies like cold chain equipment (EPI baseline).

The routine immunization schedule in
Ethiopia covers vaccine preventable diseases, namely measles, diphtheria,
pertussis, polio, tuberculosis, tetanus and hepatitis B. the vaccines are
provided for free. Before the age of one year, the routine immunizations
schedule should be completed by all children. According to EPI schedule includes
five contacts: Polio-0&BCG are given at birth. DPT1-HepB-Hib, PCV1, Rota1
and polio1 are given at the age of six weeks. DPT2-HepB-Hib, PCV2, Rota 2 and
polio2 are given at the age of 10 weeks. DPT3-HepB-Hib, PCV3 and polio3 are
given at the age of 14 weeks. Measles vaccine is given at the age of nine
months. (epi pdf)  

 A case control study conducted in Argonne
district, south Ethiopia shows that the incomplete immunization status of
children was significantly associated with young mother, being born second to
fourth and lack of knowledge about immunization benefit. The study also showed that
unavailability of vaccine on appointed date and migration of mothers were the
main reason for partial immunization of the children (26781)        

The study
conducted on the quality if vaccination in Africa (including Ethiopia) and Asia
indicated that there are number of serious shortcoming in the quality of
vaccination service and strains are apparent at the interference between te
vaccine providers and the users.  10534895                         

 

As mentioned above the immunization coverage in
Ethiopia has not reached the targeted objective and the quality of vaccination
services still leaves much to be desired, sustainable improvement in the
immunization service delivery are needed to reduce the infant and child
mortality rate in Ethiopia .so this audit is delegated to assess the current
immunization practice and to increase the quality of the service by
identification of the gaps that needs to be fulfilled.

2.AIM
AND OBJECTIVES

Aim;-To
improve the quality of pediatric immunization service in university of Gondar
hospital

Objectives

To assess the current pediatric
immunization service delivery in university of Gondar hospital

To compare the current service with
the standardized one

To establish standardized
immunization service in university of Gondar hospital

 

 

 

 

 

 

 

 

 

 

 

 

 

      Table- 1
Audit standards table for pediatric immunization service in UOGH

No/

 List of Standards

Target

Source of the
evidence

Data source

1

 Immunization services are readily available.

100%

CDC Standards for
pediatric immunization
practices. MMWR
1993

Direct
observation at EPI room

2

There are no barriers
or unnecessary prerequisites to the receipt of Vaccines.

100%

    ”    ”

 

3

Immunization services
are available free or for a minimal fee

100%

    ”    ”

 

4

Providers utilize all
clinical encounters to screen and, when
Indicated, vaccinate
children.

100%

    ”    ”
 

 

5

Providers educate
parents and guardians about immunization in general terms

100%

    ”    ”
 

 

6

Providers question
parents or guardians about contraindications and, before vaccinating a child,
inform them in specific terms about the risks and benefits of the vaccinations
their child is to receive

100%

    ”    ”
 

 

7

Providers follow only
true contraindications

100%

    ”    ”

 

8

Providers administer simultaneously all vaccine doses for
Which a child is eligible at the time of each visit.
 

100%

    ”    ”

 

9

Providers use
accurate and complete recording procedures.

100%

    ”    ”
 

 

10

Providers report
adverse events following vaccination promptly, accurately, and completely

100%

    ”    ”

 

11

Providers adhere to
appropriate procedures for vaccine Management

100%

    ”    ”
 

 

12

Providers conduct
semi-annual audits to assess immunization
Coverage levels and
to review immunization records in the patient Populations they serve.

100

    ”    ”

 

13

Providers maintain
up-to-date, easily retrievable medical protocols at all locations where
vaccines are administered

100%

    ”    ”
 

 

14

Vaccines are
administered by properly qualified proffesional.

100%

    ”    ”

 

15

Providers receive
ongoing education and training regarding current immunization
recommendations.

100%

    ”    ”
 

 

I choose these
standards because these Standards
represent the most desirable immunization practices that health-care providers
should strive to achieve to the extent possible. By adopting these Standards,
the health care providers can begin to enhance and change their own practices
and as I can see that other standards on pediatric immunization service are
sated based on this standard.

3.Audit methodology

 Audit
population

The whole vaccination session/services
delivered in Gondar university hospital.

 Audit sample

The vaccination session delivered
during time of data collection in Gondar university hospital

Consecutive non probability
sampling technique was employed until the required sample size was complete.

Data
collection method

Data was collected by direct observation
using standardized audit Performa which contain 14 standards.

Data collection period

The data was collected from 14/5/2010-17/52010 E.C.

Starting date: 14/5/2010E.C

End date: 17/52010 E.C

Presentation date  ; 25/5/2010E.C

Data
analysis

The Data has been checked for its completeness and
relevance. The data was analyzed by using tally method and presented by using
tables and pie chart diagram.

 

 

 

 

 

 

 

Table 2 :  Audit
Result

 

List of standards

 

1
 
 

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

 

 

1

Service availability

 
?

 
?

 
?
 

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

 
?

100%

 

2

No barrier to get the vaccine

?

?

×

?

×

?

?

?

?

?

?

?

?

?

?

×

?

?

?

?

?

?

?

×

?

?

×

?

?

?

83.3%

 

3

Immunization service for free

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

4

Utilize all encounter to screen

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

5

Educate parents about
immunization

×

?

×

?

×

?

×

×

?

×

×

×

?

?

×

?

?

×

×

?

×

?

?

×

?

?

?

×

×

×

46.6%

 

6

Question parents­­­­­ about CI

×

?

×

×

×

?

×

?

?

?

×

×

?

?

?

?

×

×

?

×

?

?

×

×

?

×

?

?

?

×

53.33%

 

7

Follow only true CI

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

8

Administer simultaneously all
vaccine

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

9

Complete recording

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

10

Report adverse events

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

11

Appropriate procedure for vaccine
management

?

?

?

?

?

?

?

?

?

?

?

?

?

×

?

?

?

?

?

?

×

?

?

×

?

?

?

×

×

×

80%

 

12

Conduct semiannual audit

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

13

Vaccine administered by qualified
professional

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

14

Receive ongoing training

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

×

0%

 

 

 

 

Total score =357 of 420 which is 83.1%

The total compliance rate of pediatric immunization
services was

= 83.1%

And the noncompliance rate (gap) was 16.9%.

The pie chart below shows that the percentage of
parents who got education about the importance of immunization during delivery
of the care.

 

 

Fig1; percentage of parents educated about
immunization during data collection

 

 

 

 

 

4.
Discussion

This clinical audit is conducted in university of
Gondar hospital, North West Ethiopia to assess the quality of pediatric
immunization service and the audit assed the current practice. For immunization
to be effective, it is important to provide good quality vaccination service .Out
of 30 observed vaccination delivery sessions 83.1% of the service is compliant
with the standard used. The result showed that the immunization services are
readily available and free for all children.

In all 30 care delivery session the health care
providers administer simultaneously all
vaccine doses for which a child is eligible at the time of each visit and they conduct
report to assess immunization coverage levels monthly.

In 14 (46.6%) care delivery sessions, the health care
providers educate the parents about importance of immunization, the diseases
they prevent, the need to receive Vaccinations at recommended ages and the
importance of bringing their child’s immunization record to each visit but in
the rest 16 (53.4%) care delivery sessions the health care providers did not
tell the importance of the service to the parent.

In 16 (53.3%) of the care session, the nurse question
parents about contraindications, possible history of adverse events following
prior immunizations before vaccinating a child. In the rest 46.7% the nurse
administer the vaccine for the infants without asking the occurrence of
anaphylactic reaction during the previous dose.

 

The audit showed that the care providers had not got
the up-dated ongoing training and education about the current guidelines and
protocols of immunization service.

 

 

 

 

 

 

 

 

 

 

 

5.
Conclusion

The pediatric immunization service in university of
Gondar hospital is 83.1% compliant with the standard.

Areas
of excellence practice

Availability of the immunization
service for all children and the service is given for free

The health care providers followed
only true contraindications for not giving the vaccine.

The care providers administered simultaneously all vaccine doses
for which a child is eligible at the time of each visit which is safe and
effective.

Recording
procedures was complete which includes what vaccine was administered,
the date of administration (month, day, year), the signature and title of the
person who administered the vaccine. And also the health care providers record
on the child’s personal immunization record card.

Areas
which needs to be improved

 Education for the parents about importance of
immunization at each schedule of vaccination

 Asking the parents about the anaphylactic
reaction that occurs on the pervious dose.

Provision of ongoing training for
the health care providers.

 

 

 

 

 

 

 

 

 

6.
Recommendations

Based on the audit result the following
recommendations are given for:-

The pediatric head nurse

To motivate the staff to implement
the standards of pediatric immunization practice appropriately.

The staff (nurses)

To apply the all standards during
delivery of service.

The administrations of the hospital

To  provide ongoing and updated training for the
staffs

Since the flow of the children for
vaccination is high daily, the number of health providers who works at EPI room
should be increased

7.
Action plan

 

No/

Action
to be implemented

By
whom

By
when

1

Discuss
the result with the concerned bodies

 mekdess and pediatric unit team leader(Mr.workye.M)
and Mr.Amsalu 

28/5/2010E.C

2

Provide
training for nurses about the standards of the service

Hospital
administration

5/6/2010E.C

3

Post
the standards in EPI room

mekdess
and the staffs

7/6/2010E.C

4

Re-audit

 mekdess

6/8/2010E.C

5.

Presentation
of re audit result with the concerned staff

mekdess

11/8/2010E.C

 

 

 

 

 

 

 

 

8
.Reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.
Annex

No/

 List of Standards

Yes

no

remark

1

 Immunization services are readily available.

 

 

 

2

There are no barriers
or unnecessary prerequisites to the receipt of
Vaccines.

 

 

 

3

Immunization services
are available free or for a minimal fee

 

 

 

4

Providers utilize all
clinical encounters to screen and, when
Indicated, vaccinate
children.

 

 

 

5

Providers educate
parents and guardians about immunization in
general terms

 

 

 

6

Providers question
parents or guardians about contraindications
and, before
vaccinating a child, inform them in specific terms about
the risks and
benefits of the vaccinations their child is to receive

 

 

 

7

Providers follow only
true contraindications

 

 

 

8

Providers administer simultaneously all vaccine doses for
Which a child is eligible at the time of each visit

 

 

 

9

Providers use
accurate and complete recording procedures.

 

 

 

10

Providers report
adverse events following vaccination promptly,
accurately, and
completely

 

 

 

11

Providers adhere to
appropriate procedures for vaccine Management

 

 

 

12

Providers conduct semi-annual
audits to assess immunization
coverage levels and
to review immunization records in the patient
Populations they
serve.

 

 

 

13

Vaccines are administered
by properly qualified professional

 

 

 

14

Providers receive
ongoing education and training regarding current immunization
recommendations.

 

 

 

Table 3: Audit Performa used for data collection

 

NB: – YES;-if the standard has performed or availed
accordingly         

          NO;-if the standard has not performed
and not availed