Doctor of Nursing Practice (DNP) Projects

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Embargo Period

6-2-2012

Degree Program

Doctor of Nursing Practice

Degree Track

Family Nurse Practioner

Year Degree Awarded

2012

Month Degree Awarded

May

Keywords

Tdap, Family Practice, Immunity of Pertussis

Advisor

Cynthia Jacelon, PhD, RN, CRRN, FAAN, Clinical Assistant Professor

DNP Project Chair

Cynthia Jacelon, PhD, RN, CRRN, FAAN, Clinical Assistant Professor

DNP Project Member Name

Jeungok Esther Choi, MPH, PhD, RNC

DNP Project Outside Member Name

Robert J Kitos, MD, PhD

Abstract

There has been an increase in the preventable communicable disease known as Pertussis as the result of waning immunity in adolescents and adults. Waning immunity is the loss of protective antibodies over a period of time. Despite the availability of a new immunization in 2005, adult immunization rates do not meet Centers for Disease Control (CDC) Healthy People 2020 goal. Adult immunizations remain a challenge. Preventive healthcare is the keystone to providing routine vaccination coverage. It is usually the point of entry into the health care system.

The theoretical model used was the Precaution Adoption Model, which allowed the provider the opportunity to provide immediate information to the patient at the time of the visit. This provided the patient time to make an educated decision at the time of the office visit to receive or decline the Tdap immunization.

The purpose of this project was to implement a process to increase the rate of pertussis immunity with the use of tetanus toxoid, diphtheria toxoid and pertussis immunization (Tdap) to the patients in our practice.

All patients 19 years of age and over who had a scheduled office visits in our practice, with one of our three providers were provided the questionnaire to complete on immunization status. We offered the immunization to both genders 19 years of age and older. Those patients seen by a provider daily 19 to 64 years of age were identified as study participants.

With the use of questionnaire, it was found that 21% to 40% of patients seen during the 8 weeks of project had received their Tdap immunization prior to their office visit. Once the provider offered and if indicated explained the importance of the Tdap immunization an additional 33% to 49% patients were provided the immunization. Though provided the information and recommendation 25% to 35% of those patients seen during their office visit declined the immunization. The visits during the eight week of project increased the rate of Tdap immunizations from 61% to 77% which fell short of the CDC’s goal of 90%, but was found to have a significant increase with the questionnaire.

The questionnaire used was well received by providers, staff and patients and did not increase in time requirements for the patient intake process. There were two limitations to administer the Tdap immunization in our office. The first is insurance carriers. Medicaid does not allow us to administer any immunizations in the office, so those patients with that specific insurance were unable to receive, even they wanted it. Next is those patients who rely on Medicare for payment, Medicare will not cover the Tdap administration for prevention. The second limitation is those patients who have no insurance and are self-pay refused to take due to cost. At present there is no program in our company to assist patients with financial needs to receive a reduction in cost.

This Capstone experience concluded that the primary care office and the patient’s office visit is an effective site for implementing immunization administration of Tdap to increase the public health issue of declining immunity of pertussis and the indication for immunizations.

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