Please complete the following dialysis facility information. (One Survey Per Facility CCN)

Definition of Root Cause Analysis: This tool is used to help determine the cause/reasons/specific issues preventing your facility from obtaining the goal of a 60% vaccination rate for Pnuemococcal Pneumonia (PPV) and Hepatitis B (HPV).

Please complete this RCA by February 10, 2017.
 

Contact:

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* 2. Contact:

Does your facility offer the following vaccinations?

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* 3. Does your facility offer the following vaccinations?

  Yes No
Hepatitis B Series (HBV)
Pneumococcal (PPV)
What is your current patient census?

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* 4. What is your current patient census?

According to your facility's Electronic Medical Records (EMR), what are your current vaccination rates?

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* 5. According to your facility's Electronic Medical Records (EMR), what are your current vaccination rates?

Do you have standing orders or a protocol for administrating vaccinations?

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* 6. Do you have standing orders or a protocol for administrating vaccinations?

When do you offer the vaccinations to the patient?

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* 7. When do you offer the vaccinations to the patient?

If a patient refuses a vaccine, what is done?

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* 8. If a patient refuses a vaccine, what is done?

Do you have automatic reminders that vaccinations are due?

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* 9. Do you have automatic reminders that vaccinations are due?

Do you track vaccinations in CROWNWeb:

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* 10. Do you track vaccinations in CROWNWeb:

Do you request documentation from the patient if they received a vaccination outside of the dialysis unit?

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* 11. Do you request documentation from the patient if they received a vaccination outside of the dialysis unit?

List the order in which patient barriers most impact your facility's vaccination rates:

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* 12. List the order in which patient barriers most impact your facility's vaccination rates:

List in order the barriers that most impact your facility's overall vaccination rates:

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* 13. List in order the barriers that most impact your facility's overall vaccination rates:

Do you have any other comments, questions, or concerns?

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* 14. Do you have any other comments, questions, or concerns?

 
100% of survey complete.

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