[Audit as a tool to improve the efficiency of the immunization services: the experience of a Local Health Authority in Rome].

Introduction: The Italian Ministry of Health has launched an alert about the reduction in vaccine coverage (VC), which decreased below 95% since 2014 for many paediatric vaccines, oppositely from the National Prevention Plan 2014-18 and the National Immunization Plan 2017-2019. Even though the growing vaccine hesitancy attracts the attention of the media in the last few years, the organization of an easily accessible and efficient supply network remains a crucial imperative for ensuring satisfactory and uniform vaccine coverage. Taking into consideration some critical issues identified within the vaccination centres of the Local Health Authority (ASL) RM/A, the local health management decided to improve the VC in deep collaboration with all the health professionals. The amelioration process includes the following actions: verifying the current situation, analysing the main concerns, evaluating the possible solution, and activating those already deemed feasible. This paper aims to describe in details the methodology used in the audit and to present the results and actions undertaken following this amelioration process.
Methods: In the ASL RM/A, which counts 550.000 inhabitants, all the 5 vaccination centres started from 2014 to carry out at least one 30-hour audit each year in order to improve VC. The audits are structured according to the four steps defined by the Ministry of Health to address systematically the critical points identified, by implementing the improvement actions proposed by the audit team to the health management. The audits, accredited under the ECM for the medical and nursing personnel, started in February 2014 and the last edition of the program was completed in December 2016.
Results: During 20 meetings the audit "Centri Vaccinali" involved 11 professionals from 5 vaccine centres, who acknowledged being highly satisfied with the audit, which has been recognized as a valuable tool for improving their work. Following the activities performed in the VC improvement programme, throughout the 3-years period an in-depth review of the most relevant procedures implemented daily by the involved experts was conducted. Moreover, the share of goals and deadlines among the various professionals has leaded to a positive and fruitful collaboration of all experts working in the vaccination centres. This was achieved without creating an additional burden deriving from the improvement process activities. The analysis conducted after two years from the start of the programme has shown not just a significant improvement in vaccine coverage, but also an important increase in the number of vaccine sessions and in the total number of administered vaccines.
Conclusions: Throughout the described process of improvement, the collaboration among health care professionals was significantly improved and immunization strategies were identified and shared among the centres. The audit demonstrated to be an effective methodology for facilitating the accessibility and usage of vaccination centres by the citizen/user as well as by the healthcare providers. It showed a quick and significant improvement that, by promoting accountability and transparency, will ensure greater efficacy and safety of vaccine services.