A pediatric rheumatology clinic substantially increased the pneumococcal vaccination rates of their high-risk patients through a targeted, multipart yearlong intervention, according to a recent study.
“This single-center quality improvement project to increase pneumococcal vaccination rates in eligible pediatric rheumatology clinic patients was a success that can serve as a model for other hospitals and divisions,” reported Dr. Julia G. Harris of Children’s Mercy-Kansas City in Missouri, and her associates (Pediatrics 2015 Aug. 24. [doi:10.1542/peds.2014-2512]). “Through simple quality improvement initiatives, our vaccination rates statistically increased over time and were sustained indicating a true change in practice.”
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The Centers for Disease Control and Prevention recommends that all infants receive the 13-valent pneumococcal conjugate vaccine (PCV13) four times in early childhood, with high-risk patients aged 2-5 years receiving at least one dose. High-risk patients at least 2 years old should also receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23) and continue to receive a dose every 5 years if they remain at high risk.
The researchers designed an intervention aimed at improving pneumococcal vaccination rates among children at least 2 years old and adults who had systemic lupus erythematosus and/or who were taking immunosuppressive medication.
Before the intervention, retrospective analysis of 90 patient visits in 88 patients during 4 weeks revealed that 6.7% of the patients had received the PCV13, and 8.9% had received PPSV23, but none had received both.
The intervention, which ran from September 2012 to October 2013, involved multiple components, beginning with stocking PCV13 and PPSV23 and then a formal presentation to providers and nurses about the recommendations for pneumococcal vaccines. An immunization algorithm posted throughout the clinic helped clinicians determine whether pneumococcal vaccination was indicated.
The office created a weekly email identifying patients in need of either vaccine; then the nurses would attach brightly colored pieces of paper with either PCV13 or PPSV23 written on them to patients’ clinic encounter forms to flag which patients should be immunized.
“Pneumococcal vaccines were often administered in clinic, and nurses provided an educational document regarding the specific vaccine to the patient and family,” the authors explained. Patients living out of state or who lacked an immunization record also received letters requesting immunization records to determine if they needed the pneumococcal vaccine.
During the year (53 weeks) after the intervention began, the coverage increased to 48.4% of 299 patients with 1,033 patient visits (P less than .001). Similarly, the vaccination rate with PPSV23 increased from 8.9% to 28.4%, and the combined vaccination rate for receiving both vaccines increased from 0% to 23.2%.