Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow

Second Advisor

James, Kathy, DNSc, FNP




Marissa Marquez, DNP Student, FNP-C, MSN, MBA, RN, BSN

Clinical Mentor: Jill Milton, MSN, FNP-C

Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow

Purpose: The purpose of the quality improvement project is to improve the vaccination rates and vaccine series completion rates of school age children at Rosa Parks Elementary school through a targeted educational intervention.

Background: Under immunization among school-aged children is an ongoing challenge. Low rates of immunization can cause outbreaks of communicable disease, leading to preventable injury, loss of life, and burden to the healthcare system. Among other reasons, a primary cause of low immunization is parents’ refuse due to lack of knowledge and poor access to immunization services.

Framework/EBP Model: The Iowa model is an appropriate tool for this project primarily because of its well-organized, efficient implementation and multidisciplinary team approach to promote change in practice.

Evidence for Problem: Approximately 42,000 adults and 300 children in the United States die each year from vaccine-preventative diseases. According to Mortality and Morbidity Weekly Report, San Diego County is below the Healthy People 2020 target rate of 90% and Rosa Parks Elementary School compliance rate is 80%. According to the current San Diego County, 2015 vaccination coverage statistics, compliance is only 80%. Throughout all of California for the years 2018-2019, the rate of vaccination in kindergartners stood at 43.2%.

Evidenced-based Intervention(s)/Benchmark(s): A system-based intervention will be implemented with the health care-based intervention which includes client-based education and increasing client demands for a response to vaccination. An Immunization Information System (ISS) will be utilized to provide reliable evidence of effective vaccination tracking mechanism.

Project Plan Process/Timeline: Conduct initial survey using needs assessment and barriers. Provide vaccination education classes according to the results of the assessment; tracking and follow-up via telephone and reminder cards; then, conduct vaccine audit review to verify the compliance rates.

Evaluation Results: The outcomes showed an improvement in the vaccination uptake rates and vaccine series completion rates 95%.

Cost Benefit Analysis: One (1) Measles, Mumps, and Rubella (MMR) outbreak cost $10,376, including the 1,745 hours spent on investigation and containment efforts vs. MMR vaccine cost $19/dose for public sector and $60 for the private sector. 1 case/outbreak is equal to $10,376 vs. 100 children vaccinated is equal to $1,900 ($19/dose for the public sector). Savings of $8,476.

Implications for Clinical Practice: DNPs as leaders translate research findings to practice or apply interventions that optimally improve patient care outcomes. The study also reinforces the goals of Healthy 2020 and the reports of the Institute of Medicine (2011). Improving immunization rates will lead to less injury and death from preventable, communicable diseases and less burden on the healthcare system.

Conclusions: The results of the study showed that vaccination education is necessary to improve the knowledge of parents on the importance of vaccines. Community partnership is vital to increase public awareness in improving vaccination rates.

Keywords: vaccination, immunization rates, refusal, school age and promotional strategies

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Nursing Commons