MPH 610 Week 7 Integrative Synthesis Paper Example

Integrative Synthesis: Turning One Desk's Rabies Advice Into a Written Protocol and a Quarterly Report at the Kessler County Health Department

Student Name

Chamberlain University

MPH 610: Integrative Learning Experience (ILE) and Applied Practice Experience (APE) I

Instructor Name

Month Day, Year

Integrative Synthesis: Turning One Desk's Rabies Advice Into a Written Protocol and a Quarterly Report at the Kessler County Health Department

The Problem, Restated

Over 2025, Kessler County's rabies program took in 612 animal bite reports and handled them from one desk. Analysis of the program's data showed two problems that shaped this applied practice experience. First, advice to clinicians on rabies postexposure prophylaxis, requested in about 140 cases a year, depended on whoever answered the phone, with no written protocol. Second, the program could not answer basic questions from its board, such as what share of biting dogs and cats were vaccinated, without going through a spreadsheet by hand. The program also ran at about 90% of its capacity in staff hours, so any solution had to save time rather than add it. That constraint ruled out some attractive ideas early, such as a new online bite reporting form, which would have added a system for one technician to maintain.

What I Did and What Came Out

I produced three things. The first is a clean data set of bite reports from 2023 to 2025 with a cleaning log of 14 rules, which the manager can rerun on new data; among its findings, barely half of the dogs and cats that bit someone in 2025 had a vaccination on record. The second is a two-page prophylaxis consultation protocol with a one-page call script, organized by animal type: dogs, cats and ferrets that can be observed; bats; other wildlife; and animals that cannot be found. Each section ends in a recommendation and a reason the caller can repeat. The third is the first quarterly bite surveillance report, four pages with a one-page board summary, with species-by-month rates per 100,000 residents, showing that summer reports run nearly twice the winter rate.

Where the Literature Shaped Decisions

Three decisions were made from the literature. The protocol's structure follows the national recommendations on postexposure prophylaxis, which treat dogs, cats and ferrets differently from wildlife because a healthy domestic animal can be observed for 10 days, and which call for prophylaxis to be considered after bat contacts even without a recognized bite (Rupprecht et al., 2010). I placed bats on the first page and in bold, because a bat call in week 2 showed that this is where staff were least certain. Second, a multi-site emergency department study in which two of every five prophylaxis courses were judged unnecessary, often because the animal could be observed (Moran et al., 2000), led me to make the observation option the default recommendation for vaccinated, available dogs and cats, with a script explaining why to families. Third, national surveillance showing that animal rabies is concentrated in wildlife, especially bats and raccoons (Boutelle et al., 2025), led the report to separate wildlife contacts from domestic animal bites, so the board sees risk and volume separately.

Competency, With an Address

Each selected competency is evidenced at a specific place in the products. Applying epidemiological methods: the cleaning log, rules 4 to 9, and the rate table on page 2 of the report. Interpreting data for practice: the board summary, whose staffing recommendation for the summer months rests on the seasonal rates. Written communication for an audience: the protocol's call script, tested against 10 past calls and revised after the emergency department nurse educator's comments. Interprofessional teamwork: the protocol's change log, which records four changes made after two meetings with the nurse educator and one with an attending physician, including moving the bat section first. Partnership with stakeholders: the engagement plan in my stakeholder analysis and the agreement by the emergency department's medical director to place the protocol in the department's reference folder.

What Did Not Go to Plan

Data access took nine working days instead of two because of de-identification rules, which delayed the clean data set by a week and reduced the time for the report's area analysis, which covers only three of the county's five planning areas. The health officer approved the protocol with two written changes, both clarifying when to call the state laboratory, and the revised version was returned in week 7, a week later than planned but within the placement.

What the Site Gains and What It Still Needs

The program gains a protocol that any staff member can follow and a report it can update each quarter. Neither adds hours; the technician estimates the protocol shortens a typical prophylaxis call by about five minutes. What the program still needs is a standing de-identified data extract, which the manager has requested, and a check after six months of whether clinicians start prophylaxis less often for observable animals.

Two Readers, One Document

This paper is read by my faculty advisor, who needs evidence of competency, and could be read by the division manager, who needs to know what was produced and what remains. I have kept each product's location and status explicit for both. Rabies postexposure prophylaxis is costly and, when unnecessary, avoidable; state health departments surveyed some years ago estimated national use in the tens of thousands of courses each year (Christian et al., 2009), and a county's share of unneeded courses is one of the few costs a protocol can reduce directly.

How the Products Fit Together

The three products depend on one another. The clean data set made the report possible and also supplied the protocol's examples: the 10 past calls used to test the protocol were drawn from it. The report, in turn, gives the protocol a way to be evaluated, because future quarterly reports can track how often clinicians called for advice and how many biting animals were observed rather than tested. Building them in this order meant each product strengthened the next, and none of them needs me to keep working once the placement ends.

How Long the Products Will Stay Useful

The protocol will need review whenever national or state guidance on rabies prophylaxis changes, and its reference page lists the documents it rests on so a future reviewer can check them. The report will stay useful as long as the cleaning log is followed; the manager has assigned the technician to run it each quarter, with the first unaided run planned for April. Both products are designed to outlast my placement, which is the test of whether the work served the site rather than the course.

References

Boutelle, C., Bonaparte, S., Orciari, L. A., Kirby, J. D., Chipman, R. B., Fehlner-Gardiner, C., Thang, C., Julien, D., Hirose, J. A. M., García, B. C., Wallace, R. M., & Blanton, J. D. (2025). Rabies surveillance in the United States during 2023. Journal of the American Veterinary Medical Association, 263(10), 1310-1317. https://doi.org/10.2460/javma.25.05.0344

Christian, K. A., Blanton, J. D., Auslander, M., & Rupprecht, C. E. (2009). Epidemiology of rabies post-exposure prophylaxis: United States of America, 2006-2008. Vaccine, 27(51), 7156-7161. https://doi.org/10.1016/j.vaccine.2009.09.028

Moran, G. J., Talan, D. A., Mower, W., Newdow, M., Ong, S., Nakase, J. Y., Pinner, R. W., & Childs, J. E. (2000). Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. JAMA, 284(8), 1001-1007. https://doi.org/10.1001/jama.284.8.1001

Rupprecht, C. E., Briggs, D., Brown, C. M., Franka, R., Katz, S. L., Kerr, H. D., Lett, S. M., Levis, R., Meltzer, M. I., Schaffner, W., & Cieslak, P. R. (2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recommendations and Reports, 59(RR-2), 1-9.