CQI Project

QI Project: Scenario and Data:

Synopsis:

You are a Performance Improvement Project Coordinator working for the World Health Organization. Over the past 18 months, you have been working with a team of individuals from the United States and around the world on an initiative around improving the implementation and administration of the malaria vaccine to children in sub-Saharan Africa. The following scenario and data provided are around a Malaria Vaccine Initiative in Ghana.

Now that this initiative is complete, you must create a presentation to the Board of Directors around the work that was done. Your presentation must include critical elements and explanations around why this work was needed, how it was implemented, results that were seen, and if outcomes were improved or fell flat.

This project did not present without its own challenges, though. Utilizing the data given to you and from your own research, explain the challenges that were within this project and how your team overcame them.

Your presentation must be professional, robust, and engaging so that the team’s work, dedication, ideas, and passions that were dedicated to this project over the past 18 months is articulated in such a way that your expertise is going to be utilized on future projects going forward.

*This scenario has been adapted from an initiative currently underway by the WHO.

Scenario:

Background: Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260 000 African children under the age of five die from malaria annually. To assess the knowledge and understanding that parents have around protection for their children from Malaria with this new vaccine becoming available.

Goal: With additional education and support, 95% of the children who visit the Kumasi Clinic will receive their first dose of the vaccine series.

Method: Parents of children were given a pre-survey regarding their knowledge of the malaria vaccine and benefits for their own children. After the pre-survey, parents were given the option to vaccinate their child. Afterwards, a post-survey was also conducted with these parents

Results: The proportion of participants with increased knowledge around malaria increased after intervention, respectively. Counseling was provided around appropriateness of the vaccine and education around the vaccine schedule prior to discharge. Many children did receive their first malaria vaccine of the series prior to discharge.

Conclusion: Increased vaccination rates were seen when proper education was provided to parents, with an opportunity to participate in shared-decision making.

Data:
416 non-vaccinated children were invited to participate in the study; 213 declined to participate. Ultimately, 972 non-vaccinated children’s parents agreed to be involved in the study and participated throughout the evaluation period.
A pre-survey was given to the participants to assess their level of knowledge around appropriate malaria vaccination. Questions around the survey included:
Knowledge around Malaria and transmission rates
Knowledge around RTS & S/AS01 Malaria vaccines
Knowledge around cadence of vaccine series and safety of vaccine

Pre-Survey Results:
Questions
Good Level of Knowledge
Fair Level of Knowledge
Poor Level of Knowledge
Malaria and Transmission Rates
8
149
167
RTS & S/AS01 Malaria Vaccine
9
148
169
Vaccine Schedule and Safety
9
148
165

After analyzing the pre-survey results, team members instituted a plan around a social worker meeting with all mothers prior to leaving the clinic. Prior to discharge, this social worker would provide counseling around Malaria, the vaccine, and safety.
A memo for this change was posted in the staff break room, and project management planned to look at the results around this change after 6 weeks.
A social worker who previously worked with elderly patients was moved in to working on this project and meeting with parents
If the social worker was not available to meet with patients prior to discharge, the discharge nurse was expected to complete the counseling and administer the vaccine if necessary

Number of Counseling Sessions Completed After 6 Weeks:
Parents Who Received Counseling & Vaccines Administered to Children
Discharges for that Week
Intervention 1; Week 1 (10/10-10/16)
20
65
Intervention 1; Week 2 (10/17-10/23)
16
68
Intervention 1; Week 3 (10/24-10/30)
12
62
Intervention 1; Week 4 (10/31-11/6)
13
64
Intervention 1; Week 5 (11/7-11/13)
3
70
Intervention 1; Week 6 (11/14-11/20)
8
62

After the first month, the social worker assigned to this project within the maternity ward quits. The Project Management team goes back to the drawing board and makes the following changes:
Two new team members are added, both nurses who work specifically with pediatric patients
In-person training is provided for all staff
New Social Worker hired for the position, with maternal/child experience
Vaccine Counseling Checklist created and required for use by staff at every discharge
After introducing these changes, the team decides to evaluate the number of counseling sessions after 24 weeks, with the following results:

Intervention 2; Week 1 (11/28-12/4)
31 – Number of Parents Who Received Counseling & Vaccines Administered to Children
68 – Number of Discharges for that Week

Intervention 2; Week 2 (12/5-12/11)
34 – Number of Parents Who Received Counseling & Vaccines Administered to Children
68 – Number of Discharges for that Week

Intervention 2; Week 3 (12/12-12/18)
35 – Number of Parents Who Received Counseling & Vaccines Administered to Children
61 – Number of Discharges for that Week

Intervention 2; Week 4 (12/19-12/25)
38 – Number of Parents Who Received Counseling & Vaccines Administered to Children
69 – Number of Discharges for that Week

Intervention 2; Week 5 (12/26-1/1)
33 – Number of Parents Who Received Counseling & Vaccines Administered to Children
72 – Number of Discharges for that Week

Intervention 2; Week 6 (1/2-1/8)
33 – Number of Parents Who Received Counseling & Vaccines Administered to Children
63 – Number of Discharges for that Week

Intervention 2; Week 7 (1/9-1/15)
34 – Number of Parents Who Received Counseling & Vaccines Administered to Children
65 – Number of Discharges for that Week

Intervention 2: Week 8 (1/16-1/22)
36 – Number of Parents Who Received Counseling & Vaccines Administered to Children
64 – Number of Discharges for that Week

Intervention 2; Week 9 (1/23-1/29)
37 – Number of Parents Who Received Counseling & Vaccines Administered to Children
71 – Number of Discharges for that Week

Intervention 2; Week 10 (1/30-2/5)
39 – Number of Parents Who Received Counseling & Vaccines Administered to Children
68 – Number of Discharges for that Week

Intervention 2; Week 11 (2/6-2/12)
40 – Number of Parents Who Received Counseling & Vaccines Administered to Children
70 – Number of Discharges for that Week

Intervention 2; Week 12 (2/13-2/19)
42 – Number of Parents Who Received Counseling & Vaccines Administered to Children
70 – Number of Discharges for that Week

Intervention 2; Week 13 (2/20-2/26)
39 – Number of Parents Who Received Counseling & Vaccines Administered to Children
66 – Number of Discharges for that Week

Intervention 2; Week 14 (2/27-3/5)
41 – Number of Parents Who Received Counseling & Vaccines Administered to Children
63 – Number of Discharges for that Week

Intervention 2; Week 15 (3/6-3/12)
43 – Number of Parents Who Received Counseling & Vaccines Administered to Children
65 – Number of Discharges for that Week

Intervention 2; Week 16 (3/13-3/19)
40 – Number of Parents Who Received Counseling & Vaccines Administered to Children
68 – Number of Discharges for that Week

Intervention 2; Week 17 (3/20-3/26)
44 – Number of Parents Who Received Counseling & Vaccines Administered to Children
72 – Number of Discharges for that Week

Intervention 2; Week 18 (3/27-4/2)
40 – Number of Parents Who Received Counseling & Vaccines Administered to Children
67 – Number of Discharges for that Week

Intervention 2; Week 19 (4/3-4/9)
36 – Number of Parents Who Received Counseling & Vaccines Administered to Children
70 – Number of Discharges for that Week

Intervention 2; Week 20 (4/10-4/16)
39 – Number of Parents Who Received Counseling & Vaccines Administered to Children
71 – Number of Discharges for that Week

Intervention 2; Week 21 (4/17-4/23)
28 – Number of Parents Who Received Counseling & Vaccines Administered to Children
40 – Number of Discharges for that Week

Intervention 2; Week 22 (4/24-4/30)
20 – Number of Parents Who Received Counseling & Vaccines Administered to Children
32 – Number of Discharges for that Week

Intervention 2; Week 23 (5/1-5/7)
48 – Number of Parents Who Received Counseling & Vaccines Administered to Children
68 – Number of Discharges for that Week

Intervention 2; Week 24 (5/8-5/14)
50 – Number of Parents Who Received Counseling & Vaccines Administered to Children
73 – Number of Discharges for that Week

At the end of the 18 weeks, a post-survey was given to the 203 randomized participants who had received counseling around Malaria vaccination. Again, this assessed their level of knowledge around Malaria and transmission rates, vaccines, and safety.

Questions
Good Level of Knowledge
Fair Level of Knowledge
Poor Level of Knowledge
Malaria and Transmission Rates
266
50
8
RTS & S/AS01
189
125
10
Vaccine Schedule and Safety
274
38
12

Additional data collected during post-survey:
150 Families reported that they plan to continue and complete the vaccine series
15 Families reported that the counseling provided around vaccines was not helpful
172 Familie reported that they found the counseling helpful and necessary to process this decision
189 Families reported that cultural and familial expectations have the highest impact on whether or not to vaccinate their own children

Six months after the Malaria Vaccine Counseling process and checklist was introduced, the Project Management team asked for feedback from the 25 nurses who work within the pediatric clinic. Staff provided the following feedback:
25/25 nurses believe that counseling, options, and education around the new Malaria vaccine needs to be provided to all families
9/25 nurses report that they complete the Malaria Vaccine Counseling Checklist when appropriate
21/25 nurses report that additional staff is needed to complete the checklist and many would also benefit from additional education around this new process

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