Catherine Eppes

Barriers to influenza vaccination among pregnant women

OBJECTIVE Despite pregnant womens increased morbidity and mortality from influenza, vaccination rates remain low. This study intended to evaluate barriers to pregnant womens uptake of influenza vaccine. STUDY DESIGN A survey was designed that assessed participant demographics, knowledge, beliefs, attitudes, and general experiences with seasonal and 2009 novel H1N1 influenza. Associations between patient characteristics and vaccine uptake were then assessed. RESULTS 88 women completed the survey. Women who correctly answered >75% of knowledge questions regarding influenza were significantly more likely to accept the influenza vaccine (seasonal: p=0.04, H1N1: p<0.01). Conversely, patients who declined the vaccine were more likely to hold false beliefs, such as perceiving that the vaccine was not protective (seasonal: p<0.01, H1N1: p<.01) and that they were not at risk for influenza (seasonal: p< 0.01). CONCLUSION The reasons for influenza vaccine declination in pregnant patients include lower levels of knowledge and unfavorable attitudes regarding the safety and efficacy of the vaccine, and suggest the importance of education as a tool to improve vaccination uptake.

Telephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population

We sought to determine the safety and efficiency of a telephone-based triage system for influenza-like illness, during the 2009 pandemic, at our institution. A triage system was implemented that involved initial telephone screening by a provider who determined whether outpatient telephone-based care or assessment in a centralized evaluation unit was needed. Those who received outpatient care were empirically treated. Those seen in the evaluation unit were assessed for inpatient admission. Of the 230 women who were evaluated, 41% were treated as outpatients and 59% were seen in the evaluation unit. Of those treated as outpatients, 9% were eventually seen in the evaluation unit and only 4% were ultimately admitted, with a maximum hospitalization of 4 days. Of the 135 patients initially seen in the evaluation unit, 32% were admitted and 44% had a positive polymerase chain reaction for respiratory pathogens. This triage system improved efficiency of resource utilization without incurring apparent influenza-like illness morbidity.

The development and implementation of checklists in obstetrics

&NA; Checklists have been long used as a cognitive aid in various high‐stakes environments to improve the reliability and performance of individuals and teams. When designed well, implemented thoughtfully, and monitored closely, they offer the opportunity to improve the performance of health care teams and advance patient safety. There are different types of checklists; examples include task lists, troubleshooting lists, coordination lists, discipline lists, and to‐do lists. Each is useful in different situations and requires different implementation strategies. Checklists also are different from algorithms, care maps and protocols, and educational tools. Therefore, they are not useful in all situations. In appropriate selected clinical circumstances, checklists are tools that can help standardize care, improve communication, and help teams perform optimally.