Morris Regional Public Health Partnership

1
Morris Regional Public Health Partnership

• A mini-collaborative with the NJ Collaborative
  for
• Excellence in Public Health
• Improving Documentation of Seasonal Influenza
  Vaccination in Childcare Settings

2
The Situation

• Annually 3,000- 52,000 people die from seasonal
  influenza.
• 20,000 children are hospitalized annually with
  complications.
• Highly contagious, can cause high fever,
  pneumonia and make existing medical conditions
  (asthma) worse.
• Can cause dehydration and seizures in children.
•  

3
The Situation

• New Jersey mandated influenza vaccinations in
  preschool and childcare settings in the 2008-2009
  influenza season
• 2008-2009 due to vaccine shortage the mandate was
  lifted
• During the 2009-2010 influenza season, that
  mandate was lifted, due to shortages of seasonal
• influenza vaccine and a focus on H1N1

4
The Situation

• During annual immunization audits in February
  2010, public health nurses observed many children
  without any documentation of their seasonal
  influenza vaccination status.
• Little data existed other than some had
  documentation and some did not.
•  

5
The Situation

• No plans were in place to consistently encourage
  the immunization of children against the flu and
  the subsequent documentation of that vaccine.

6
AIM STATEMENT

• By February 1, 2011 the rate of documentation of
  seasonal influenza vaccination status among
  preschool and childcare centers will increase
  from 57 to 80.

7
Plan

• First step was to audit the schools to establish
  baseline documentation.

8
Plan

• Fishbone analysis to identify barriers and
  supports.
• Developed a sub-committee of public health nurses
  to gather data and develop a targeted project to
  design an intervention.
•  

9
Fishbone Diagram
10
Do

• The committee developed a survey instrument for
  distribution to preschool and childcare center
  personnel, to help identify the barriers to
  documentation and their relative importance.
• The survey was piloted among a sample of 10
  centers. It was revised and fielded via
  telephone to a total of sixty-two Preschool and
  Childcare centers. A 100 survey participation
  rate was achieved.

11
Do

• Barriers to influenza vaccination status
• documentation identified in the survey were
• Uncertainty of state mandate requiring
• flu vaccine for children (73)
• Inconsistency among parents in submitting
  documentation of vaccination, even when the
  vaccine was received (56 )

12
Do(Barriers continued)

• Concerns among parents about the vaccines safety
  and whether or not it was even necessary. (66
  stated vaccines safety and 47 stated vaccine
  was unnecessary)
• 64 of the respondents cited access/availability
  of vaccine as an issue
• 25 cited inconvenience to schedule

13
Do

• Another contributing factor the forms used by
  schools to document vaccination status (generally
  referred to as IMM-8 or yellow immunization
  cards) were outdated.
• Lacked the visual trigger to follow up on
  influenza vaccinations.

14
Do

• 85 indicated that their local health department
  was a source of guidance and information
• 100 were satisfied with this source for
  information

15
Do

• Other barriers 
• Lack of understanding of the state.
• mandate and their legal responsibility.
• Lack of availability of childhood flu vaccine in
  fall 2009.
• For fall 2010, LHDs participating
• in this effort offered flu vaccine to
  children.
• Lack of knowledge and understanding of antigens
  and brand names of vaccines.

16
Do

• Based on the survey data obtained, a Tool Kit
  format was decided
• Upon and developed for Childcare Directors.
• The Tool Kit included
•  Sample IMM-8 as they should correctly be
• completed for each age group.
• Charts demonstrating the brand names and the
  antigens they contain. A separate chart listed
  the specific diseases and the brand names that
  covered them.
• Sample parent letters.
• Vaccine resources, including science-based
  information to address concerns of parents who
  are hesitant to vaccinate and
• to empower Center Directors to answer questions.
• New Jersey Communicable Disease Reporting
• Requirements.

17
Do

• Orientation was
• provided onsite to
• each Center
• Director by the
• Public Health
• Nurse.

18
Study

• An evaluation instrument was developed to
  measure the effectiveness of the Tool Kit. Public
  Health Nurses fielded this instrument in January
  2011, via telephone to Center Directors.

19
Study

• The results of this evaluation process are below 
•  Data collected from the survey was extremely
  positive
• 95 stated that they had used the Tool Kit
• 100 stated that they would use it again
• 85 stated that they used it as a reference when
  recording immunizations
• Tool Kit rated 94 in terms of clarity and 94 in
  terms of usefulness

20
Study

• The yellow section with immunization guidelines
  was the most valuable to them.

21
Study

• Comments from Preschool and Childcare Center
  directors
• It is a lifesaver
• Tool Kit is awesome especially the vaccination
  combination names.
• Every Childcare center should have one of these.
  My sister centers keep calling me for questions
  because they know I have this Tool Kit
• I pull out this more than anything else
• Self explanatoryhelped out
• with parents so I could explain
• what each kid needed

22
Study

• Documentation of flu vaccination 94

23
Act

• Recommended changes based on results of the
  follow
• up survey and 2011 annual immunization audits
•  
• Health departments will send out reminder of
  State-Mandated influenza vaccine in October.
  Include a statement of the fines for
  non-compliance within the Tool Kit.
• Continue to measure documentation of
• seasonal influenza annually.
• If funds allow, continue to conduct pre-audits in
  November to encourage Preschool and Childcare
  Center Directors to document influenza.

24
Act

• Unanticipated Outcomes
• Tool Kit addressed the broader picture of
  vaccinations, documentation and communicable
  disease reporting
• The Tool Kit received excellent feedback and
  peaked interest of Preschool and Childcare
  Centers.
• The process of surveying and one-to-one education
  strengthened relationships between LHDs and
  Preschools and Childcare Centers

25
Next Steps

• The Tool Kit will be modified as needed and made
• available on the Morris Partnership for Public
• Health website, at http//morrispublichealth.org
• so that all childcare providers throughout Morris
• County can easily access it.

26
Team Members

• Kathy Gonzalez, East Hanover Township Health
  Department
• Helen Giles, Mount Olive Township Health
  Department
• Susan DeGraw, Pequannock Township Health
  Department
• Ginny Maico, Randolph Township Health Department
• Arlene Stoller, Morris County Office of Health
  Management
• Joan Swanson, East Hanover Township Health
  Department
• Colleen Hintz, Randolph Township Health
  Department
• Cindie Bella, Morris County Office of Health
  Management

27
Morris Regional Public Health Partnership

• A mini-collaborative with the NJ Collaborative
  for
• Excellence in Public Health
• Measuring Customer Satisfaction of
• Risk 2 and 3 Food Service Managers

28
The Situation

• The goal for the Morris Regional Public Health
  Partnership is to improve the quality of
  regulatory inspections of Risk Type 2 and Risk
  Type 3 retail food establishments.
• A Risk Type 2 food establishment has a limited
  menu.
• A Risk Type 3 food establishment has a menu
  requiring the handling of raw ingredients and
  complex preparation that includes the cooking,
  cooling, and reheating of at least three or more
  potentially hazardous foods.

29
AIM STATEMENT

• By March 2011, 30 of Risk Type 2 and Risk
  Type 3 retail food establishment operators
  located in the MLC3 region will rate their
  satisfaction with the regulatory retail food
  program by completing and returning a customer
  satisfaction survey.

Source http//www.google.com/images?qpictureof
persontakingasurveyum1ieUTF8sourceunivei
9Ew4Taa9BpSugQeIq4CjCAsaXoiimage_result_group
cttitleresnum1ved0CB8QsAQwAAbiw1131bih57
2
30
Plan

• a fishbone diagram (next slide) to pinpoint
  barriers and supports for the process
• Develop aim statement
• Create sub-committee of REHSs
• Develop survey
• Pilot survey
• Administer survey
• Evaluate

31
Fishbone Diagram
32
Do

• Survey developed
• Organized survey into sections
• timing
• performance
• rules
• enforcement
• The purpose of the survey was to gauge the
  satisfaction of the retail food operators with
  the health department regulatory inspections.

33
Do

• In May, 2010, the draft instrument was
• pilot-tested on a small group of Risk Type 2
• and Risk Type 3 retail food establishment
  owner/operators at
• Mount Olive Townships food handler class.
• Based on the comments and problems
• identified with the instrument, appropriate
• revisions were made to the instrument.
•  

34
Do

• The final survey, together with a cover letter
  and a self-addressed
• stamped envelope, was mailed to a total of 570
  Risk Type 2 and Risk Type
• 3 retail food establishments in
• East Hanover Township
• Mount Olive Township
• Pequannock Township
• Randolph Township
• (color coded to differentiate Risk Type 2
• Risk Type 3 retail food establishments).
• The mailing also included establishments that
  contract
• with these municipalities and are located within
  Morris County.

35
Study

• After the target survey response
• rate of 30 was reached,
• the survey data was entered
• into a computer-based survey
• instrument (Zoomerang)
• where each question was
• statistically analyzed.

36
Retail Food Establishments as Recorded on
12/31/2009
Morris Regional Public Health Partnership QI
Project
Total Risk 2/3 Number Number Number Who
Municipality Establishments Risk 2 Risk 3 Responded to Survey
East Hanover Township 88 31 57 -
Mount Olive Township 173 66 107 -
Pequannock Township 218 117 101 -
Randolph Township 91 28 63 -
Total 570 242 328 210
Percentage Responded 23.50 22.73 24.08 36.80
37
Study

• Key findings
• The most significant finding
• was that over 50 of the retail food
• owners/operators were seeking
• additional food handler/safety
• classes to be offered
• for their employees

38
Retail Food Owner/Operator Satisfaction Survey
I would like the health department to offer a
food safety class for my employees.
39
Study

• Team members were also able to identify from
  survey results whether they were performing a
  quality inspection, and whether or not the
  restaurant owners were acquiring useful
  knowledge from the inspection process.

40
Study

• Findings of the survey
• Restaurant owners preferred inspections to be
  conducted at times when the establishment is not
  busy.
• Request for more food handlers classes.

41
Act

• Educate food establishments during inspections
  why they need to be inspected when busy.
• Pilot county-wide food handlers class.

42
Act

• In addition, the group will plan, develop and
• implement an on-line course in targeted languages
• for all food handlers interested in on-line
  training

43
Act

• The survey will be implemented yearly
• for ongoing customer satisfaction improvement.

44
Unanticipated Outcomes

• The involvement of REHSs from the four separate
  heath departments became advantageous, as all
  team members could provide useful information.
• By working collectively, the REHSs
• experienced the added benefit of gaining
• knowledge from each other, both for this
• effort and for other common work activities.

45
Next Steps

• The survey will be revised using a Likert scale
  and distributed to the remaining Morris County
  municipalities that have not yet participated
• Ongoing survey distribution to retail food
  establishments is likely, and additional surveys
  for other regulated entities is also being
  considered

46
Next Steps

• The REHSs involved are considering implementing
  quarterly meetings for all REHSs in Morris
  County since working with staff from the four
  health departments served to be a constructive
  addition to their profession.

47
Next Steps

• A comprehensive effort to provide food handlers
  education will be developed. This will include
• An in-class food handlers course will be offered
  in English and Spanish to all interested food
  handlers

48
Next Steps

• An on-line food handlers class, consisting of a
  comprehensive Food Safety Training Manual, pre
  and post-test, and final printable certificate
  upon passing the post-test.
•  

49
Next Steps

• Distribution of the Food Safety
• Training Manual during both
• regulatory inspections and
• during pre-operational
• inspections, so new food
• establishment owners/operators
• to gain food safety knowledge.

50
Team Members

• Kathy Nguyen, East Hanover Township Health
  Department
• Carl Reiners, Mount Olive Township Health
  Department
• Gail Gratzel, Pequannock Township Health
  Department
• Tim Zachok, Pequannock Township Health
  Department
• Stephanie Gorman, Pequannock Township Health
  Department
• Fatima Hurst, Pequannock Township Health
  Department
• Steve Widuta, Randolph Township Health Department

51
Morris Regional Public Health Partnership (MRPHP)
Members

• Carlo DiLizia, Health Officer, President, MRPHP
• Mark Caputo, Health Officer ,Vice President,
  MRPHP
• Peter Correale, Health Officer, Chairperson
  Program Committee,
  MRPHP
• Robert Schermer, Manager, MRPHP
• Carlos Perez, Health Officer, Morris County
  Office of Health Management
• Frank Wilpert, Health Officer, Mount Olive
  Township, Immunization Quality
  Improvement Project Leader

52
The Multi State Learning Collaborative

• Lead States in Public Health Quality Improvement
  is managed by the National Network of Public
  Health Institutes with support form the Robert
  Wood Johnson Foundation.
• Learn more about these activities at
• http//morrispublichealth.org