UNIVERSITY OF GONDAR COLLEGE OF MEDICINE AND HEALTH SCIENCES

                                                      UNIVERSITY
OF GONDAR

COLLEGE
OF MEDICINE AND HEALTH SCIENCES

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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 OPD unit) for helping me during the data
collection period.

  

 

 

 

 

List of Acronyms and abbreviations      

1.

2. CI-contra indications

3.EPI-expanded program of immunization

4.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/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. (epi pdf)

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 the most recent EPI review,
conducted in 2001, constraints 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 knowelege 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
trained persons.

100%

    ”   

 

 

15

Providers receive ongoing education
and training regarding current immunization recommendations.

100%

    ”   

 

 

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

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 trained person

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

?

100%

 

14

Receive
ongoing training

×

×

?

×

?

×

×

×

×

?

?

?

?

?

×

?

×

×

×

×

×

×

×

×

×

×

×

×

×

×

26%

 

 

 

 

Total score =357 of 420 which is 85%

The total compliance rate of pediatric immunization
services was

= 85%

And the noncompliance rate (gap) was 15%.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 85% 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. Because

 

 

 

 

 

 

 

 

 

 

 

5.
Conclusion

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

·        
The staff should apply the standards
during delivery of service.

·        
To the managers of the hospital

Ø  It
is better provide ongoing and updated training for the staffs

Ø  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

 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 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.

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

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

 

 

 

9 .Reference