Pneumococcal vaccination process improvement in an acute care setting.

BACKGROUND AND OBJECTIVE: Despite the availability of the pneumococcal vaccine since 1977, the vaccine is greatly underutilised. Centers for Medicare and Medicaid Services, The Joint Commission and Healthy People 2010 have all listed the administration of the pneumococcal vaccine before hospital discharge as a standard of care and a quality initiative in the 21st century. SSM St Mary's Health Center chartered a multidisciplinary team to address a disappointing pneumococcal vaccination rate of 34.7% in the first quarter of 2005. METHODS: The team utilised the improvement model of Plan-Do-Study-Act to implement and monitor process changes. Changes were made to four key steps in the pneumococcal vaccination process: assessment, ordering, obtaining and administering. The team also implemented a concurrent review process. The team tracked the hospital's pneumococcal vaccination rate per the published Centers for Medicare and Medicaid Services and The Joint Commission guidelines. RESULTS: Over a 2-year period, the vaccination rate of pneumonia patients has improved incrementally from 34.7% and is now consistently greater than 90%. CONCLUSION: Utilising Plan-Do-Study-Act allows for continual improvement of the vaccination process. Multiple cycles are necessary to achieve standardisation and optimal process flow.

Exhaust system burn injuries in children.

BACKGROUND/PURPOSE: The authors had noted a number of children who had sustained burn injuries from the exhaust systems of recreational vehicles and wished to document the incidence of pediatric burn injury sustained from the exhaust systems of a wide scope of motorized vehicles. METHODS: The authors conducted a 10-year retrospective chart review including all children admitted to our institution with burn injuries from contact with vehicular exhaust systems. RESULTS: Twenty-three children were included. There were 18 boys, with a median patient age of 7 years. Most children (7 of 23) were injured from the exhaust systems of all-terrain vehicles. The average burn size (5%) was small, but almost two thirds of the burn injuries were full thickness. Of the 23 children, 21 required operative intervention for their burns, with 2 children requiring multiple surgical interventions. The average length of hospital stay was 11 days, and all children, except one who went to a rehabilitation facility, were discharged to home. CONCLUSIONS: Pediatric health care providers should be aware that exhaust system contact burns in children are not rare events and they do tend to be significant. Surgical consultation should be requested early in the management of these particular burn injuries in children.