Immunization entry at the point of service improves quality, saves time, and is well-accepted

Objective. Computer-based immunization tracking is a routine part of many p ediatric practices; however, data quality is inconsistent and entry often r elies on dedicated data entry personnel and is time-consuming, expensive, o r difficult. The purpose of this study was to evaluate data quality, nursin g satisfaction, and reduction in documentation burden after the introductio n of a point-of-service immunization entry system in an inner-city pediatri c primary care center. Design. Prospective preintervention and postintervention study. Methods. Visit records from all pediatric nonurgent care visits for patient s <5 years old were collected during a 2-week period before (preinterventio n) and after (postintervention) the introduction of a computer-based immuni zation entry system. Nurses used software designed to allow rapid entry dur ing immunization preparation followed by printing 2 adhesive labels for doc umentation. Satisfaction was evaluated using an 8-question survey administe red 3 months after the intervention. Results. One hundred forty-seven (63.6%) of 231 preintervention and 132 (51 .4%) of 257 postintervention children received at least 1 immunization (imm unized) during the study visit. Gender and mean age were similar for immuni zed children in the 2 groups. In the preintervention group, 56 (37.9%) of 1 47 immunized children had at least 1 dose missing (a total of 128 of 343 do ses administered) from the immunization tracking database compared with non e in the postintervention group. Medical record review showed that 92.6% of preintervention and 91.4% of postintervention children were on-schedule af ter the study visit. However, missing data lead to the misclassification of preintervention children-only 68.4% were reported by the database to be on -schedule. All 9 nurses reported using the program all the time to enter im munizations, 89% said that the program required somewhat or a lot less time , and 100% strongly recommended continued use of the program. All 9 nurses also reported that they would be somewhat or very unenthusiastic about the system if labels were not available. During the 12 months after introductio n of the system, 8273 forms containing immunization information were printe d, preventing nurses from having to write >101 000 dates. Conclusions. Immunization entry by nurses at the time of immunization prepa ration improves the quality of tracking data, reduces misclassification of immunization needs, saves time, and can be well-accepted. It is likely that poor data quality in some tracking systems has led to falsely low immuniza tion coverage estimates. Systems such as the one in this study can improve quality and should be integrated into routine clinical practice.