NRS 493 Grand Canyon University Influenza Vaccinations Capstone Paper Write a 500-750 word description of your proposed capstone project topic: Influenza V

NRS 493 Grand Canyon University Influenza Vaccinations Capstone Paper Write a 500-750 word description of your proposed capstone project topic: Influenza Vaccinations/Vaccines challenges regarding the community (must have a thesis statement in the first paragraph/description.) Include the following:

The problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project that will be the focus of the change proposal.
The setting or context in which the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project can be observed.
A description (providing a high level of detail) regarding the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
Effect of the problem or issue, intervention, quality initiative, educational need, or collaborative interprofessional team project.
Significance of the topic and its implications for nursing practice.
A proposed solution to the identified project topic with an explanation of how it will affect nursing practice.

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You are required to cite to a minimum of eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice. Plan your time accordingly to complete this assignment.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Course Code
NRS-493
Class Code
NRS-493-OL191
Criteria
Content
Percentage
80.0%
Project Topic for Focus of Change Proposal
5.0%
Setting or Context Where Project Topic Is
Observed
10.0%
Detailed Description of Project Topic
15.0%
Effect of Identified Problem or Issue
15.0%
Topic Significance and Implications for Nursing
Practice
15.0%
Proposed Solution for Identified Project Topic
and Implications for Nursing Practice
15.0%
Peer-Reviewed Articles
5.0%
Organization, Effectiveness, and Format
20.0%
Thesis Development and Purpose
5.0%
Argument Logic and Construction
5.0%
Mechanics of Writing (includes spelling,
punctuation, grammar, language use)
5.0%
Paper Format (use of appropriate style for the
major and assignment)
2.0%
Documentation of Sources (citations, footnotes,
references, bibliography, etc., as appropriate to
assignment and style)
3.0%
Total Weightage
100%
Assignment Title
Capstone Project Topic Selection and Approval
Unsatisfactory (0.00%)
The problem or issue, intervention, quality initiative,
educational need, or collaborative interprofessional team
project that will be the focus of the change proposal is
omitted.
The setting or context in which the problem or issue,
intervention, quality initiative, educational need, or
collaborative interprofessional team project can be observed
is omitted.
A description of the project topic is omitted.
Effect of the identified problem or issue, intervention, quality
initiative, educational need, or collaborative interprofessional
team project is omitted.
Significance of topic and its implications for nursing practice is
omitted.
A proposed solution to the identified project topic with an
explanation of how it will affect nursing practice is omitted.
Fewer than six peer-reviewed articles are presented.
Paper lacks any discernible overall purpose or organizing
claim.
Statement of purpose is not justified by the conclusion. The
conclusion does not support the claim made. Argument is
incoherent and uses noncredible sources.
Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.
Template is not used appropriately, or documentation format
is rarely followed correctly.
Sources are not documented.
Total Points
60.0
Less Than Satisfactory (75.00%)
The problem or issue, intervention, quality initiative,
educational need, or collaborative interprofessional team
project that will be the focus of the change proposal is
presented but is largely incomplete.
The setting or context in which the problem or issue,
intervention, quality initiative, educational need, or
collaborative interprofessional team project can be observed
is presented but is largely incomplete.
A description of the project topic is presented but is largely
incomplete.
Effect of the identified problem or issue, intervention, quality
initiative, educational need, or collaborative interprofessional
team project is presented but is largely incomplete.
Topic is presented but criteria are incomplete.
Topic is presented but criteria are incomplete.
Fewer than seven peer-reviewed articles are presented.
Overall, only five articles meet the assignment criteria.
Thesis is insufficiently developed or vague. Purpose is not
clear.
Sufficient justification of claims is lacking. Argument lacks
consistent unity. There are obvious flaws in the logic. Some
sources have questionable credibility.
Frequent and repetitive mechanical errors distract the
reader. Inconsistencies in language choice (register), sentence
structure, or word choice are present.
Template is used, but some elements are missing or
mistaken; lack of control with formatting is apparent.
Documentation of sources is inconsistent or incorrect, as
appropriate to assignment and style, with numerous
formatting errors.
Satisfactory (79.00%)
The problem or issue, intervention, quality initiative,
educational need, or collaborative interprofessional team
project that will be the focus of the change proposal is
summarized. There are some omissions or inaccuracies. Some
support is needed.
The setting or context in which the problem or issue,
intervention, quality initiative, educational need, or
collaborative interprofessional team project can be observed
is summarized. There are some omissions or inaccuracies.
Some support is needed.
A description of the project topic is presented. There are
some omissions or inaccuracies. Some support is needed.
Effect of the identified problem or issue, intervention, quality
initiative, educational need, or collaborative interprofessional
team project is summarized. There are some omissions or
inaccuracies. Some support is needed.
Topic and most criteria are presented. There are some
omissions or inaccuracies. Some support is needed.
Topic and most criteria are presented. There are some
omissions or inaccuracies. Some support is needed.
Eight peer-reviewed articles are presented. Overall, only six
articles meet the assignment criteria.
Thesis is apparent and appropriate to purpose.
Argument is orderly but may have a few inconsistencies. The
argument presents minimal justification of claims. Argument
logically, but not thoroughly, supports the purpose. Sources
used are credible. Introduction and conclusion bracket the
thesis.
Some mechanical errors or typos are present, but they are
not overly distracting to the reader. Correct and varied
sentence structure and audience-appropriate language are
employed.
Template is used, and formatting is correct, although some
minor errors may be present.
Sources are documented, as appropriate to assignment and
style, although some formatting errors may be present.
Good (89.00%)
The problem or issue, intervention, quality initiative,
educational need, or collaborative interprofessional team
project that will be the focus of the change proposal is
presented. Minor aspects are unclear or require support.
The setting or context in which the problem or issue,
intervention, quality initiative, educational need, or
collaborative interprofessional team project can be observed
is presented. Minor aspects are unclear or require support.
A description of the project topic is presented. Minor aspects
are unclear or require support.
Effect of the identified problem or issue, intervention, quality
initiative, educational need, or collaborative interprofessional
team project is presented. Minor aspects are unclear or
require support.
Topic and criteria are presented. Minor aspects are unclear or
require support.
Topic and criteria are presented. Minor aspects are unclear or
require support.
Eight peer-reviewed articles are presented. Overall, only
seven articles meet the assignment criteria.
Thesis is clear and forecasts the development of the paper.
Thesis is descriptive and reflective of the arguments and
appropriate to the purpose.
Argument shows logical progression. Techniques of
argumentation are evident. There is a smooth progression of
claims from introduction to conclusion. Most sources are
authoritative.
Prose is largely free of mechanical errors, although a few may
be present. A variety of sentence structures and effective
figures of speech are used.
Template is fully used; There are virtually no errors in
formatting style.
Sources are documented, as appropriate to assignment and
style, and format is mostly correct.
Excellent (100.00%)
The problem or issue, intervention, quality initiative,
educational need, or collaborative interprofessional team
project that will be the focus of the change proposal is clearly
and logically presented. Support and rationale are evident.
The setting or context in which the problem or issue,
intervention, quality initiative, educational need, or
collaborative interprofessional team project can be observed
is logically presented. Support and rationale are evident.
A detailed description of the project topic is clearly and
logically presented. Support and rationale are evident.
Effect of the identified problem or issue, intervention, quality
initiative, educational need, or collaborative interprofessional
team project is clearly and logically presented. Support and
rationale are evident.
Topic and criteria are clearly and logically presented. Support
and rationale are evident.
Topic and criteria are clearly and logically presented. Support
and rationale are evident.
Comments
Eight peer-reviewed articles are presented, and each article
clearly meets the assignment criteria.
Thesis is comprehensive and contains the essence of the
paper. Thesis statement makes the purpose of the paper
clear.
Clear and convincing argument presents a persuasive claim in
a distinctive and compelling manner. All sources are
authoritative.
Writer is clearly in command of standard, written, academic
English.
All format elements are correct.
Sources are completely and correctly documented, as
appropriate to assignment and style, and format is free of
error.
Points Earned
CME
AMY CUNNINGHAM, PHD, MPH, JOHN STOECKLE, MD,
VICTOR DIAZ, MD, GEORGE VALKO, MD, AND CHRISTINE ARENSON, MD
BACK TO BASICS:
FIVE STEPS TO BETTER INFLUENZA
VACCINATION RATES
nfluenza results in up to 710,000 hospitalizations and
up to 56,000 deaths per year in the United States.1
Although the effectiveness of flu vaccines varies, vaccination is still the best way to reduce flu-related illnesses and deaths. In addition to protecting individuals, a
high vaccination rate within a population also offers
“herd immunity,” which reduces the chance of a flu outbreak and helps protect the most vulnerable, such as
infants and others unable to receive the vaccine. Since
2010, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Pre-
vention (CDC) has recommended flu vaccination for
patients six months and older who do not have contraindications.1 Because of the impact on quality and cost,
Medicare and other payers are increasingly incorporating
flu vaccination rates as an individual quality measure in
value-based payment models. So improvements can affect
not only your patients’ health but also your bottom line.
Unfortunately, the flu vaccine rate remains low. Only
59.3 percent of children and 41.7 percent of adults
received an influenza vaccination during the 2015 – 2016
flu season.2
Downloaded from the Family Practice Management website at www.aafp.org/fpm. Copyright © 2017
American
Academy of| www.aafp.org/fpm
Family Physicians. |For
the private, noncommercial
use of one individual user of the website.
30 | FAMILY PRACTICE
MANAGEMENT
November/December
2017
All other rights reserved. Contact copyrights@aafp.org for copyright questions and/or permission requests.
© M I K E AU S T I N
I
Getting more patients immunized against the flu
does not require complicated strategies.
Our family medicine practice has 48 faculty members
and providers in downtown Philadelphia serving 35,000
patients through more than 80,000 visits per year. More
than half of our patients are racial or ethnic minorities,
and many of our patients come from underserved communities. To meet the needs of such a large and diverse
patient population, our practice leaders must navigate
many competing quality priorities.
After becoming part of the Delaware Valley Accountable Care Organization (ACO) in 2015, we were charged
with improving our flu vaccination rate of 66 percent,
which was below our goal. We considered several systemand provider-level strategies and were able to improve our
2016 – 2017 flu vaccination rate to 82 percent using five
key tactics. (See “Key tactics for improving flu vaccination rates.”)
1. Find a champion
Identify a physician or other health professional in your
office to lead the flu vaccination campaign. The champion should be both familiar with current vaccination
guidelines and enthusiastic about improving flu vaccine
rates. He or she should communicate regularly with
office providers and staff to share current vaccination
information and bolster enthusiasm and commitment to
flu vaccination. In some offices, a champion also recruits
an immunization coordinator from among the providers
or staff to oversee logistics of vaccine purchasing, storage,
administration to patients, and billing.3
In our practice, we benefited from having multiple
champions from our practice quality team, including our
medical director, assistant medical director, and several
embedded team nurses. The leaders of our institution
and ACO supported our efforts in a number of ways,
including our implementation of standing orders.
2. Use standing orders
Because physicians must accomplish many tasks in an
office visit, consider using protocols to empower other
team members to assess immunization status and administer vaccinations without an examination or a direct
order from the physician. The Community Preventive
KEY TACTICS FOR IMPROVING
FLU VACCINATION RATES
1. Find a champion
2. Use standing orders
3. Optimize your documentation
4. Provide regular reminders
5. Give ongoing feedback
Services Task Force and the ACIP recommend the use
of standing orders based on strong evidence of their
effectiveness.4,5
The American Academy of Family Physicians recently
supported Take a Stand: Use Standing Orders to Improve
Adult Immunization Rates, a campaign led by the Immunization Action Coalition (IAC) to promote the use of
vaccination standing orders.4 The IAC website contains
many resources to help practices get started, including
standing order requirements and templates to aid in the
development of a comprehensive protocol. (See “Elements of a standing order for vaccines,” page 32.) Since
state laws vary, consult your state immunization program
or licensing boards to determine who can sign a standing
order in your state and which health professionals are
permitted to administer vaccinations.5 You should also
obtain necessary legal approvals from your organization.
It will also be necessary to thoroughly train clinicians and
staff on the standing order protocol. The training should
also emphasize the importance of providing CDC Vaccine Information Statements (see https://www.cdc.gov/
vaccines/hcp/vis/index.html), properly documenting the
vaccine lot number, and entering other key information
in the medical record.
Our compliance officers approved the use of standing orders so that medical assistants could administer flu
vaccines. As part of the patient visit, the medical assistant
informs the patient that “The doctor would like you to
have the flu shot” and administers the shot unless the
patient refuses. Using encouraging, opt-out language –
rather than asking if the patient would like the flu
shot – increases the likelihood that a patient will accept
About the Authors
Amy Cunningham is a postdoctoral research fellow in the Department of Family and Community Medicine at the Sidney Kimmel
Medical College of Thomas Jefferson University in Philadelphia. Dr. Stoeckle is a clinical instructor and population health fellow in
the Department of Family and Community Medicine. Dr. Diaz is an assistant professor in the Department of Family and Community
Medicine and assistant medical director and quality improvement director for Jefferson Family Medicine Associates in Philadelphia.
Dr. Valko is a professor in the Department of Family and Community Medicine and medical director of Jefferson Family Medicine
Associates. Dr. Arenson is an alumni professor and chairwoman of the Department of Family and Community Medicine. Author disclosures: no relevant financial affiliations disclosed.
November/December 2017 | www.aafp.org/fpm | FAMILY PRACTICE MANAGEMENT | 31
the vaccine. Some may argue that an opt-out
policy reduces patient autonomy, but we feel
the greater good that results from vaccination,
such as herd immunity, makes this the right
approach. The fact that the medical assistant
delivers the message rather than the physician
reduces the power differential somewhat, and
we do still find that patients are comfortable
refusing the vaccine.
To increase flu
vaccination rates,
practices need to
identify key health
professionals who
will lead the effort.
Standing orders
allow nonphysicians
to assess immunization status and
administer vaccinations, which
frees physicians for
higher level work.
3. Optimize your documentation
Providers and support staff may need some
brief training about how to appropriately
document their flu vaccine discussions with
patients. For instance, if a patient reports having received the vaccine elsewhere, that information needs to be captured in the chart. For
the influenza vaccination measure contained
in Medicare’s new Quality Payment Program,
providers can report a performance exclusion
if the patient already received the shot, has a
relevant allergy, declined the shot, or could
not receive the shot due to a health system
reason such as a vaccine shortage.
Enhanced documentation will improve
your performance on flu vaccination quality
measures. Furthermore, documenting vaccines
received elsewhere and patient refusal helps
ensure that you are targeting your vaccination
efforts to the appropriate patients. Of course,
documenting patient refusal should only be
done after a careful provider-patient conversa-
ELEMENTS OF A STANDING ORDER FOR VACCINES
• Which populations should receive the vaccine.
• W ho should not receive the vaccine based on indications,
contraindications, or precautions.
• How to administer the vaccine (including vaccine name, dosage,
and route of administration).
• W hat information is required by federal law (e.g., the Vaccine
Information Statement).
• How to document the vaccination in the medical record.
• W hat medical emergencies may occur during vaccine administration
and how to manage them.
• How to report adverse events that occur after vaccine
administration.
Source: Using standing orders for administering vaccines: what you should know. Immunization Action Coalition. http://www.immunize.org/catg.d/p3066.pdf. Accessed Sept. 6, 2017.
32 | FAMILY PRACTICE MANAGEMENT | www.aafp.org/fpm | November/December 2017
tion, because patients may change their mind
regarding vaccination. (For more on this topic,
see “How to Talk to Reluctant Patients About
the Flu Shot,” FPM, Sept/Oct 2017, http://
www.aafp.org/fpm/2017/0900/p6.html.)
4. Provide regular reminders
Reminding providers regularly about the flu
vaccine – including guidelines, availability,
tips for patient discussions, and procedures
for documentation and billing – can also
improve vaccination rates. Our office issued
practice-wide email reminders and made vaccination-related announcements at physician
and staff meetings.
Point-of-care reminders can also boost vaccine administration. Some electronic health
records (EHRs) can be programmed to issue
a best practice alert notifying the provider if
the patient being seen has received the flu vaccine that season and, if not, the reason it was
not received. These alerts can substantially
increase documented flu vaccine discussions
and vaccination rates.6
If your practice cannot implement EHR
alerts, other reminder methods can be effective. One practice created a brightly colored
flu vaccine form that clinic staff attached to
the front of each patient’s chart. The form
encouraged providers to discuss flu vaccination with patients and record if the patient
received the vaccine at the visit or the reason
why not. From this simple intervention alone,
the practice’s flu vaccination rate increased by
12 percent.7
Reminders regarding flu vaccination can
also be sent to patients through EHR portal
messages, emails, phone calls, or postcards.
Text message reminders are an increasingly
popular method of distributing flu vaccine
reminders because they reach a large population quickly and inexpensively.8
5. Give ongoing feedback
Regularly evaluating the practice’s p…
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