UNIVERSITY SCHOOL OF NURSING DEPARTMENT PEDIATRIC AND CHILD HEALTH

                                                      UNIVERSITYOF GONDARCOLLEGEOF MEDICINE AND HEALTH SCIENCESSCHOOLOF NURSINGDEPARTMENTPEDIATRIC AND CHILD HEALTH NURSING Assessment of pediatric immunization service inuniversity of Gondar hospital        By:mekdess wesenyeleh     ID No: GUR/     Email: [email protected]

comSubmitted to: Mr. AmareHailekiros(BSc, MSc)                        Email:[email protected]      AcknowledgementFirst, I would like to thank Mr Amare Hailekiros forgiving this clinical audit  project as anassignment and for providing the course.and secondly, I would like to thankdepartment of pediatric and child health nursing for involving this course inthe curriculum and writing the supportive letter to the hospital.

Finally, my deepest acknowledgment goes to Mr. WorkiyeMulugeta (head nurse of pediatric OPD unit) for helping me during the datacollection period.       List of Acronyms and abbreviations       1.2. CI-contra indications 3.EPI-expanded program of immunization4.FMOH-federal minister of health 5.

WHO-world health organization                 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.

Audit Performa. 10 9.Reference. 11     List of tables and figures                   1.

BACKROUND/RATIONALInfant mortality rate and under five mortality rateis highest in Ethiopia. Vaccine preventable disease, malnutrition and diarrhealdisease are the major causes for childhood death in Ethiopia and otherdeveloping country. (epi pdf)Immunization is indisputably one of the most costeffective and lifesaving intervention to protect children from VPD (vaccinepreventable disease).

(EPI BASELINE)The expanded program of immunizationstarted in Ethiopia in 1980 by Ethiopian federal minister of health (FMoH) withthe intension of increasing the immunization coverage by 10% annually and reach100% coverage 1990.to achieve the goal, the Ethiopian FMoH developed strategiesand schedule for providing vaccines to the under one year children based on therecommendation of WHO. Despite the huge effort made over decades by federalministry of health along with WHO, UNICEF and other partners, the expansion ofthe immunization service fell short of the target set for 1990. According to the most recent EPI review,conducted in 2001, constraints of the program are lack of supervision, highdrop-out rates, inadequate number of trained health workers and inadequatesupplies like cold chain equipment (EPI baseline).

The routine immunization schedule inEthiopia covers vaccine preventable diseases, namely measles, diphtheria,pertussis, polio, tuberculosis, tetanus and hepatitis B. the vaccines areprovided for free. Before the age of one year, the routine immunizationsschedule should be completed by all children. According to EPI schedule includesfive contacts: Polio-0&BCG are given at birth. DPT1-HepB-Hib, PCV1, Rota1and polio1 are given at the age of six weeks. DPT2-HepB-Hib, PCV2, Rota 2 andpolio2 are given at the age of 10 weeks. DPT3-HepB-Hib,PCV3 and polio3 aregiven at the age of 14 weeks. Measles vaccine is given at the age of ninemonths.

(epi pdf)   A case control study conducted in Argonnedistrict, south Ethiopia shows that the incomplete immunization status ofchildren was significantly associated with young mother, being born second tofourth and lack of knowelege about immunization benefit.the study also showed thatunavailability of vaccine on appointed date and migration of mothers werethe  main reason for partial immunizationof the children(26781)        The studyconducted on the quality if vaccination in Africa (including Ethiopia ) and Asiaindicated that there are number of serious shortcoming  in  thequality of vaccination service and strains are apparent at the interferencebetween te vaccine providers and the users. 10534895                           As mentioned above the immunization coverage inEthiopia has not reached the targeted objective and the quality of vaccinationservices still leaves much to be desired, sustainable improvement in theimmunization service delivery are needed to reduce the infant and childmortality rate in Ethiopia .so this audit is delegated to assess the currentimmunization practice and to increase the quality of the service byidentification of the gaps that needs to be fulfilled.2.

AIM AND OBJECTIVESAim;-Toimprove the quality of pediatric immunization service in university of Gondarhospital Objectives·        To assess the current pediatricimmunization service delivery in university of Gondar hospital·        To compare the current service with thestandardized one·        To establish standardized immunizationservice in university of Gondar hospital                   Table-1 Audit standards table forpediatric 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 trained persons. 100%     ”    ”     15 Providers receive ongoing education and training regarding current immunization recommendations. 100%     ”    ”     3.Audit methodology Audit population·        The whole vaccination session/servicesdelivered in Gondar university hospital. Audit sample ·        The vaccination session delivered duringtime of data collection in Gondar university hospital ·        Consecutive non probability sampling techniquewas employed until the required sample size was complete.Data collection method·        Data was collected by direct observationusing standardized audit Performa which contain 14 standards.

Datacollection periodThe data was collected from 14/5/2010-17/52010 E.C.Starting date: 14/5/2010E.CEnd date: 17/52010 E.CPresentation date  ; 25/5/2010E.CData analysis The Data has been checked for its completeness andrelevance. The data was analyzed by using tally method and presented by usingtables 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 ü    ?   ?   ?     ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ?   ? 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 proffesional ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 100%   14 Receive ongoing training × × ? × ? × × × × ? ? ? ? ? × ? × × × × × × × × × × × × × × 26%      Total score =357 of 420 which is 85%The total compliance rate of pediatric immunizationservices was= 85% And the noncompliance rate (gap) was 15%.                    4. DiscussionThis clinical audit is conducted in university ofGondar hospital, North West Ethiopia to assess the quality of pediatricimmunization service and the audit assed the current practice. For immunizationto be effective, it is important to provide good quality vaccination service .

Outof 30 observed vaccination delivery sessions 85% of the service is compliantwith the standard used. The result showed that the immunization services arereadily available and free for all children.In all 30 care delivery session the health careproviders administer simultaneously allvaccine doses for which a child is eligible at the time of each visit and they conductreport to assess immunization coverage levels monthly.In 14 (46.

6%) care delivery sessions, the healthcare providers educate the parents about importance of immunization, the diseasesthey prevent, the need to receive Vaccinations at recommended ages and theimportance of bringing their child’s immunization record to each visit but inthe rest 16 (53.4%) care delivery sessions the health care providers did nottell the importance of the service to the parent. In 16 (53.3%) of the caresession, the nurse question parents about contraindications, possible historyof adverse events following prior immunizations before vaccinating a child. Inthe rest 46.7% the nurse administer the vaccine for the infants without askingthe occurrence of anaphylactic reaction during the previous dose. The audit showed that the care providershad not got the up-dated ongoing training and education about the current guidelinesand protocols of immunization service. Because            5.

ConclusionThepediatric immunization service in university of Gondar hospital is 85%compliant with the standard.Areas of excellence practice ·         Areas which needs to be improved·                         6. Recommendations·        The pediatric head nurse Ø  Shouldmotivate the staff to implement the standards of pediatric immunizationpractice appropriately.·        The staff should apply the standardsduring delivery of service.

·        To the managers of the hospital Ø  Itis better provide ongoing and updated training for the staffsØ  Sincethe flow of the children for vaccination is high daily, the number of healthproviders who works at EPI room should be increased7. Action plan   No/ Action to be implemented By whom By when 1 Discuss the result with the concerned bodies  audit leader 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 Audit leader and the staffs 7/6/2010E.C 4 Re-audit By project leader 7/8/2010E.C            8.

Audit Performa 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 trained persons.       14 Providers receive ongoing education and training regarding current immunization recommendations.         I choose these standardsbecause these Standards represent themost desirable immunization practices that health-care providers should striveto achieve to the extent possible.

By adopting these Standards, the health careproviders can begin to enhance and change their own practices and as I can seethat other standards on pediatric immunization service are sated based on this standard.NB:- YES;-if the standard has performedor availed accordingly                    NO;-if the standard has not performedand not availed     9 .Reference