Paper instructions:
Upload the annotated bibliography portion of your chapter topic presentation. This has to include 3 references that are from academic journals. Each source must

include the full reference as it would appear on a “reference” or “work cited” page followed by a summary paragraph about that source.

A definition and sample of an annotated bibliography can be found at Owl at Purdue. The definition of an annotated bibliography is found at

http://owl.english.purdue.edu/owl/resource/614/01/. Please note that you are only summarizing. You are not reflecting or evaluating.  An example of annotated

bibliographies is found at http://owl.english.purdue.edu/owl/resource/614/02/ and samples of different formatting are found at

http://owl.english.purdue.edu/owl/resource/614/03/

#67
hep b vaccination
Paper instructions:
Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).

A.  Develop a written proposal by doing the following:

1.  Identify a problem or issue related to practice, policy, population, or education that aligns with organizational priorities that you seek to solve.

Note: You may need to meet with the organization/practice setting, your manager, and/or supervisor to help choose a current problem or issue.

a.  Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.

2.  Discuss your investigation of the problem or issue.

a.  Include evidence to substantiate the problem or issue (e.g. organizational assessment, national source documents, evidence from a stakeholder).

3.  Analyze the state of the situation using current data.

a.  Analyze areas that might be contributing to the problem or issue.

4.  Propose a solution or innovation for the problem or issue.

a.  Justify your proposed solution or innovation based on the results of your investigation and analysis.

5.  Recommend resources to implement your proposed solution or innovation.

a.  Include a cost benefit analysis of your proposed solution or innovation.

6.  Include a timeline for implementation based on your proposal.

7.  Identify key stakeholders and/or appropriate partners that are important for the implementation of your solution or innovation.

a.  Discuss why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation.

b.  Summarize your engagement with the key stakeholders and/or appropriate partners, including the input and feedback you received.

c.  Discuss how you intend to work with those key stakeholders and/or appropriate partners in order to achieve success.

8.  Discuss how your proposed solution or innovation could be implemented.

a.  Discuss how the implementation could be evaluated for success.

B.  Explain how you fulfilled the following roles during your process of investigation and proposal development:

1.  scientist

2.  detective

3.  manager of the healing environment

C.  Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership experience.

D.  When you use sources, include all in-text citations and references in APA format.

Hepatitis B Monitoring
Western Governor University
EBT1
Marcia Michael
06/26/2014

Hepatitis B Monitoring

Dialysis patients are at an increased risk of contracting the Hepatitis B Virus (HBV).  This is do to compromised immune systems in these patients as well as exposure

to blood products.  HBV can cause chronic hepatitis, cirrhosis, or hepatocellular carcinoma.  Current guidelines warrant dialysis facilities to screen all patients for

HBV and to adhere to strict infection control policies.  According to the Centers for Disease Control the rate of HBV infections for dialysis patients has declined by

95% in recent years (2013).  Despite this decline it remains up to dialysis facilities to have policies in place to control the spread of HBV.    Hepatitis B

vaccination is essential for dialysis patients as they have high chances of getting HBV (Wörns, 2008).

Bayside Dialysis Center

Bayside Dialysis Center is a small dialysis unit located in Queens, NY.  It serves 108 hemodialysis patients and 10 peritoneal dialysis patients.  Upon admission to

the facility all patients are tested for HBV antibodies.  If it is found that the patient has no antibodies, a series of vaccines is administered.  Tracking of

antibody levels and vaccination is currently done through electronic medical records.  Using the electronic medical records a monthly report is generated, see Appendix

A.  This report shows the number of susceptible patients, immune patients, patients refusing vaccination, and patients that have not yet been vaccinated.  This report,

however, does not show the names or any identifying information for these patients.  Currently, it has been the responsibility of the staff nurses to review each

patient record individually to determine which patients are susceptible.  This current practice poses a problem because, as evidenced in Appendix A, less than 50% of

susceptible patients are vaccinated.  It is my belief that a monthly report should be generated with patients’ names and the charge nurse or nurse manger should be

assigned to review the report monthly.  By doing this nursing staff will know exactly who needs to be vaccinated and when.  This would also reduce nurses’ workloads by

utilizing a report instead of having to review each patient’s electronic medical record.

Current Practice

Bayside Dialysis current policy states: the HBV vaccine shall be offered to all susceptible patients, and all patients shall be tested upon admission and 1-2 months

after vaccination; patients that are found to be HBV positive are no longer dialyzed in the facility.  These policies where issued in March 2013 by Frensius Medical

Care, the corporation that owns Bayside Dialysis center.  The policies are in line with the 2008, Centers for Medicare and Medicaid Services (CMS) conditions for

coverage.  The policies were then adopted by the facility’s governing body and posted for staff.  Due to tight CMS regulations the facility would not have been allowed

to stay open without this policy in place. The current policy is lacking information regarding tracking susceptible patients.

Supporting Literature

In past studies, it was found that the uremic patients, vaccinated prior to dialysis, had more antibody titers and were more seroprotected. The reaction to hepatitis B

vaccination is more effective in children than in adults. For immunosuppressed and hemodialysis patients, an increased dose number and higher dosage of vaccine is

required (Nahar, 2011). In case a smaller dose of the vaccination is administered to children or adults, there should be a repetition of the dosage.

Adult hemodialysis patients are not likely to have a high antibody level requiring vaccination with the normal dosage of Hepatitis B vaccination.  Khamene & Sepehrvand

(2007) conducted a single unit study of 161 hemodialysis patients in Iran.  The study found that only 14.18% of patients were immune to HBV.  The researchers concluded

that that the current status of vaccination of patients on maintenance HD, against hepatitis B is not satisfactory.

Amongst hemodialysis patients with positive response to this vaccination, a number of clinical HBV infection was noted in patients who did not maintain a 10 mlU/mL or

greater of anti-HB concentrations.   Serologic testing of the hemodialysis patient is vital in determination of response to the vaccination. This testing is

recommended 1 to 2 months after administering the last series of the vaccination dose (Ghadiani, et al 2012). This is done by use of a method that determines level of

the anti-HBs protection, which should be 10mIU/mL or greater. For those with lower 10mIU/mL levels of anti-HBs following a series of vaccinations, they must to be

vaccinated again with another series of this vaccination.

According to Richards, et al 2012 the persistent outbreaks of HBV in hemodialysis centers has been attributed to noncompliance with guideline recommendations for

isolation, infection control, and vaccination.  Implementing an immunization protocol by nurses has led to improved vaccination rates and longevity of seroprotection.

It is very important to find more effective ways to prevent HBV infection in the society especially immunosuppressant and hemodialysis patients (Somi, & Hajipour

2012).

Clinical Implications

Increasing vaccination rates of dialysis patients would have a direct impact on patient quality of life.    It is recommended that patients be vaccinated as early as

possible in renal disease (Somi, & Hajipour 2012). By making patients’ immune the HBV they have a reduced likelihood of developing chronic hepatitis, cirrhosis, or

hepatocellular carcinoma; as these are complications of HBV.  Vaccination in turn will increase patient overall quality of life.

The clinical implications also would affect facility staff, as staff would have a lower risk of contracting HBV from vaccinated patients.  Another staff implication is

reduced workload.  Nurses would have a single report to view for the tracking of patient vaccinations.  This would cut down on the time needed to review each

individual chart.  Knowing that increased vaccination would have positive implications for staff and patients, it is vital to find more effective ways to increase

vaccination rates.

Key Stakeholders

In order to continue providing dialysis care to patient’s facilities must comply with CMS conditions for coverage.  For New York State the conditions for coverage

warrant all patients to be offered HBV vaccinations.  Bayside Dialysis attempts to meet this requirement but continues to fall short of having 100% of patients in

compliance with this policy.  The plan to implement a monthly report would be introduced to the facility’s governing body.  The governing body is composed of a Nurse

Manager, Medical Director, and Area Manager.  The need for a new policy can be evidenced using current facility data.  The governing body would have the opportunity to

review current monthly report and a sample of a possible new report.  The new report would show patient name, antibody level, patient consent or refusal, vaccination

due dates/given dates.  Current facility report is lacking specific patient information.  After comparing the reports governing body could assess the need for improved

tracking of HBV vaccinations.

Instituting Facility Change

When instituting facility change there are many factors that should be considered.  With the case of implementing new HBV policy, 2 possible issues could arise.  The

first issue would be staff resistance to change.  Secondly, there may be an issue of protecting patient health information.

In dealing with staff resistance to change, education of staff would be required.  Characteristics of an ideal HBV vaccination program include institutional commitment

to the program, trained and knowledgeable staff who promote vaccination (Richards, et al 2012).  If staff is knowledgeable about HBV and have a good understanding of

new tracking policy they will be more likely to accept new requirements.

Healthcare facilities should be diligent in protecting patient health information (PHI).  When creating new report careful consideration should be taken so that PHI is

protected.  The new implemented report should be posted in a restricted area, only available to direct patient care staff.  This will insure information is not viewed

by non-essential personnel, patients, or families.

Implementation

Upon admission patients should be given information regarding HBV and asked to consent or decline vaccination.  The patient responses should be charted in the

electronic medical record as well as logged on new tracking sheet.  HBV titers will be drawn per standing facility policy.  Titer results should be logged in

electronic record and on new tracking sheet.  With this information gathered, staff nurse will input vaccine schedule on tracking sheet and update sheet with each dose

of the vaccine given.  The new tracking sheet should be reviewed monthly by charge nurse of nurse manager.  The charge nurse or nurse manager would then assign

vaccinations to staff nurses as part of patient care.

References:

Ahuja, T., Kumar, S., Mansoury, H., Rodriguez, H., & Kuo, Y. (2005). Hepatitis B
vaccination in human immunodeficiency virus-infected adults receiving
hemodialysis. Kidney International, 67(3), 1136-1141.

Drachman, R., Isacsohn, M., Rudensky, B., & Drukker, A. (1989). Vaccination against
hepatitis B in children and adolescent patients on dialysis. Nephrology, Dialysis,
Transplantation: Official Publication Of The European Dialysis And Transplant
Association – European Renal Association, 4(5), 372-374.

Ghadiani, M., Besharati, S., Mousavinasab, N., & Jalalzadeh, M. (2012) Response rates
to HB vaccine in CKD stages 3-4 and hemodialysis patients. National Institutes of
Health , 6, 33. Retrieved January 1, 2014, from

http://www.ncbi.nlm.nih.gov/pubmed/23626628

Hepatitis 2013, September 24 Centers for Disease Control and Prevention. Retrieved
June 26, 2014, from http://www.cdc.gov/hepatitis/Settings/hemo.htm

Khamene, Z., & Sepehrvand, N. (2007). The status of immunity against the hepatitis B
virus among vaccinated hemodialysis patients: a single center report from Iran.
Saudi Journal Of Kidney Diseases And Transplantation: An Official Publication
Of The Saudi Center For Organ Transplantation, Saudi Arabia, 18(4), 547-550.

Nahar, K., Jahan, M., Nessa, A., & Tabassum, S. (2011). Antibody responses after
hepatitis B vaccination among maintenance haemodialysis patients. Bangladesh
Medical Research Council Bulletin, 37(3), 88-91.

Richards, K., & Hayney, M. (2012). Improving hepatitis B vaccination rates in the
hemodialysis population. Journal Of The American Pharmacists Association:
Japha, 52(4), 542-544. doi:10.1331/JAPhA.2012.12528

Somi, M. H., & Hajipour, B. (2012) Improving Hepatitis B Vaccine Efficacy in End-
Stage Renal Diseases Patients and Role of Adjuvants. ISRN Gastroenterology,
2012 , 9. Retrieved , from http://www.hindawi.com/journals/isrn.gastroenterology/2012/960413/

Wörns, M., Teufel, A., Kanzler, S., Shrestha, A., Victor, A., Otto, G., & … Höhler, T.
(2008). Incidence of HAV and HBV infections and vaccination rates in patients
with autoimmune liver diseases. The American Journal Of Gastroenterology,
103(1), 138-146.