Improving Influenza Vaccination Rates Among Pediatric Hematology and Oncology Inpatients

Ashley Duvall

Disclosures

Pediatr Nurs. 2019;45(3):142-154+ (box o. 

In This Article

Abstract and Introduction

Abstract

Background: Children are extremely vulnerable to complications of influenza, and the most effective prevention strategy is receiving the vaccine annually. The Centers for Disease Control and Prevention (CDC) recommends that all providers offer the influenza vaccine to unvaccinated children during routine health care visits and hospitalizations.

Local Problem: The CDC reported only 59.3% of children in the United States received the influenza vaccine during the 2015–2016 flu season. A large academic pediatric hospital inpatient hematology/oncology unit was identified as having an inadequate influenza vaccine screening and administration process.

Interventions: An influenza vaccine screening tool served to identify eligible patients and allow electronic access to notify providers to order influenza vaccines by generating a physician order notification. Education was provided. An interprofessional approach was taken, and collaboration between all departments – nursing, providers, pharmacy, and information technology – was significant in enhancing the process.

Results: Data analyses revealed the rate of influenza vaccine administration among eligible hematology/oncology patients was 5.88% pre-intervention and 43.9% post-intervention. The System Usability Scale (SUS) by Brooke (1996) was used to gain feedback from nurses and evaluate the quality improvement (QI) initiative. Each SUS was calculated; scores ranged from 30 to 100. These results are variable, and thus, indicate that the process steps could be further streamlined to improve ease and efficiency.

Conclusion: Implementation of a well-designed influenza vaccine screening tool combined with an automatic trigger to communicate with the provider increases the likelihood that the patient will receive the influenza vaccine. Implications for healthcare providers should focus on use of the electronic health record to improve the influenza vaccine screening and administration process for pediatric inpatients, especially immunocompromised patients.

Introduction

Influenza, also known as flu, is a highly communicable respiratory illness caused by influenza viruses (Centers for Disease Control and Prevention [CDC], 2016a). People of all ages are affected by the virus, but the pediatric population is especially at risk. Children are extremely vulnerable to complications of influenza, and the most effective way to prevent influenza is by receiving the vaccine each year (CDC, 2016a; Teufel, Basco, & Simpson, 2008). Data from the National Immunization Survey-Flu (NIS-Flu) and Behavioral Risk Factor Surveillance System (BRFSS) reveal that seasonal influenza vaccination coverage for children (age 6 months to 17 years) was only 59.3% during the 2015–2016 flu season (CDC, 2016b). Influenza vaccine coverage in the state of Maryland was 51.7%, and coverage in the nearby state of Virginia was only 49.5% for the 2015–2016 influenza season (CDC, 2016b).

Healthy People 2020 set a national goal to increase the percentage of children (age 6 months to 17 years) who are vaccinated annually to 70% (Office of Disease Prevention and Health Promotion, 2014). The CDC (2016a) recommends that all providers offer the vaccine to unvaccinated children during routine healthcare visits and hospitalizations. There are significant potential cost savings of delivering influenza vaccination to high-risk hospitalized children, as much as $5.45 per child screened and $9.19 per child vaccinated (Teufel et al., 2008). Recent studies support the need for multifaceted quality improvement (QI) initiatives to increase influenza vaccination in high-risk pediatric inpatients (Freedman, Reilly, Powell, & Bailey, 2015; Hofstetter, LaRussa, & Rosenthal, 2015). Freedman and colleagues (2015) employed multiple strategies, including electronic medical record (EMR) automatic alerts, re-building of vaccine order into the admission order set, and improving family and provider education. This multiprofessional process change increased vaccination rates from 20.1% to 64.5% for oncology patients at the Children's Hospital of Philadelphia (Freedman et al., 2015).

A large academic pediatric hospital inpatient hematology/oncology unit was identified as having an inefficient influenza vaccine screening and administration process. The first step to improving this process was to develop an electronic influenza screening tool that would be embedded into the admission database. This screen was made available on the hematology/oncology unit on November 1, 2016. However, implementation of this screening tool alone resulted in only a small increase in vaccine administration. Pediatric patients with chronic illnesses and those who are immunocompromised, such as on the hematology/oncology unit, are extremely vulnerable to complications of influenza (Aigbogun, Hawker, & Stewart, 2015).

The purpose of this project was to use an automated physician notification in combination with a vaccine screening tool and an educational campaign for families, nurses, and providers, and evaluate the impact of these interventions on the influenza vaccination rate of children in a hematology/oncology unit. The primary aim was to identify eligible children in the inpatient setting and provide influenza vaccines prior to discharge. Anticipated outcomes of this project were to improve compliance with use of the electronic screening tool, decrease missed opportunities for vaccinating children against influenza, and increase influenza vaccine administration rates on the hematology/oncology unit.

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