Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

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BACKGROUND: Over forty million Americans are currently infected with human papillomavirus (HPV). HPV can cause life threatening cancers of the cervix, vagina, vulva, penis, anus, and throat. Only half of U.S. adolescents have completed the HPV vaccine series.

LOCAL PROBLEM: The setting for this evidence-based improvement project is a rural family practice clinic in Texas. Texas has the largest group of teenagers not protected against HPV in the country. The project’s purpose is to investigate the effect of age-based flagging on adolescent vaccination rates in a rural community through evidence-based practice.

METHODS: Project implementation followed the Johns Hopkins Evidence Based Practice model. Two reports were run on Practice Suite (EHR) to provide a list of all patients aged eight to eighteen seen at the clinic from May 1st to July 31st in 2022 and 2023. Pre and post test scores were calculated and averaged.

INTERVENTIONS: HPV education was provided to all office staff with a pre/posttest covering HPV statistics, vaccine facts and how to answer frequently asked questions by parents. Evidence-based HPV pamphlets were made for parents and adolescents aged eight to eighteen including facts and frequently asked questions from the CDC. Clinic staff were instructed to ensure parents received a pamphlet. Nurses and aids were also asked to alert providers using the blue door flag at each clinic room.

RESULTS: There was a 25.7% increase in post test scores after staff education. HPV vaccination rates were compared for May through July 2022 and May through July 2023. In 2022 1.16% of patients received HPV vaccinations compared to 7.25% in 2023. There was a statistically significant increase in vaccination rates as assessed by Fisher's exact test, p = .001.

CONCLUSIONS: Educational pamphlets and room flagging were proven to significantly improve vaccination rates at no extra cost to the community or clinic.

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