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Local Success Stories

Carson Valley Medical Center in Nevada Achieves PPV Rate of 82 Percent— NV Hospital

Carson Valley Medical Center (CVMC), a critical access hospital, is setting the standard for health care in Gardnerville, Nevada and across the country. A collaborative effort spearheaded by the quality improvement manager, the med-tele nurse manager, the director of nursing, the pharmacist, and the medical staff has resulted in a 34 percent improvement in pneumonia vaccination rates among CVMC patients.

CVMC’s goal is to ensure that all patients who are eligible to receive the pneumonia vaccine (PPV) are appropriately screened and are given the opportunity to receive the vaccine during hospitalization.

To achieve their goal, CVMC implemented many of the best practices known to improve inpatient vaccination rates, including:

  • Implementing medical staff approved clinical practice guidelines designating the pneumonia vaccine as a standing order for patients with a primary diagnosis of pneumonia.

  • Working with the pharmacist to develop electronic medication administration records indicating that the pneumonia vaccine should be administered at discharge.

  • Updating the nursing admission assessment to include a question about when the patient last received the pneumonia vaccine.

  • Revising discharge orders to include the pneumonia vaccine.

  • Placing an article in the medical staff newsletter explaining the importance of the vaccine.

  • Providing quarterly performance feedback to the physicians.

These efforts, combined with support from physicians and staff, have led to commendable results. CVMC’s baseline PPV rate (April 2005 - March 2006) was 48 percent. Their current rate (January 2006 - December 2006) is 82 percent. The national average for this time period is 71 percent and the Nevada average is 58 percent.

We would like to congratulate the staff of CVMC. By making PPV an institutional priority they were able to dramatically increase their vaccination rate in less than a year, and protect their patients from the often deadly disease of pneumonia.

A Success Story from Utah CAH’s and PPV – Utah Hospitals

HealthInsight, the Medicare Quality Improvement Organization for Utah, worked with four reporting Critical Access Hospitals (CAHs) to develop reliable processes for providing PPV to pneumonia patients. Process components addressed were patient assessment, ordering, dispensing, and administration of the vaccine. The goal was a 10 percent reduction in failure rate, and all four hospitals exceeded that goal. One hospital improved from a baseline average of 0 percent (3Q & 4Q2004) to 67 percent in 4Q2006 and 91 percent in 1Q2007. A second hospital started with a baseline average of 50 percent and has been consistent at 100 percent since 2Q2006. A third hospital improved from its baseline of 0 percent to 100 percent since 3Q2006. The fourth hospital’s baseline was 70 percent, and they improved to 75 percent in 4Q2006 and 85 percent in 1Q2007.

A Success Story from Jordan Valley Hospital – Utah Hospital

Jordan Valley Hospital in Salt Lake City, Utah worked with HealthInsight, the state’s QIO, to use Medicare quality data to evaluate areas where it could improve and use quality tools and techniques to make significant changes in pneumococcal and influenza vaccination rates. The pneumococcal vaccination rate improved to 97 percent by the first quarter of 2007 from a baseline of 28.6 percent in the second quarter of 2004. Influenza vaccination rates started at 85.7 percent in the fourth quarter of 2004, increasing to 100 percent in the first quarter of 2007.

A Success Story from University of Utah – Utah Hospital

Working with HealthInsight in 2006, University of Utah Hospitals and Clinics (UUHC) in Salt Lake set a goal to improve discharge instruction for heart failure patients. In the second quarter of 2006, only 33 percent of heart failure patients were receiving discharge instructions. Preventive Cardiology, and an inpatient education team, decided to take on heart failure a small group of nurses met with the Quality and Patient Safety Department to discuss a plan to find and teach heart failure patients in the hospital. After many trials and errors, it was decided that Lasix would be the trigger that would help determine which patients may have heart failure. If a patient is on Lasix, further research is done into their medical history to determine if they do have heart failure. A standardized instruction sheet was then created to educate patients about taking their medicines, eating a low salt diet, exercising and weighing themselves daily, and knowing when to call their doctor. In the second quarter of 2007, 93 percent of heart failure patients were receiving heart failure education.

Discontinuing Antibiotics Post-Op. A Success Story from The Orthopedic Specialty Hospital – Utah Hospital

While there is ample evidence that prolonged post-op antibiotic administration can lead to problems: increased antibiotic resistance, increased potential for adverse drug events and increased cost. Nevertheless, at The Orthopedic Specialty Hospital (TOSH) in Salt Lake City, Utah staff and quality managers were skeptical that with discontinuation rates as low as 3 percent in 2005, they would ever see success in this measure. In 2006 however, antibiotic discontinuation rates climbed from 15 to 82 percent. In 2006 Intermountain Healthcare’s regional CEO challenged surgeons to give process change a trail. The surgical services quality coordinator and TOSH pharmacy director proposed an evidence-based alternative dosing schedule to the chief of staff who agreed to amend his post-op antibiotic. The successful implementation was complex and involved creating communications links throughout the system, communications and feedback were the keys to making the process work. The chief of staff keeps the physicians and MEC appraised of progress and helps to educate new physicians. Changes in medications and nursing staff require good communication between nursing and pharmacy. Ongoing success requires vigilance, but TOSH’s improvement shows that success can be found, even in difficult situations when a systems approach is understood and applied.