Improving Influenza Vaccination Rates Among Pediatric Hematology and Oncology Inpatients

Ashley Duvall


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

In This Article


Results suggest that an automated physician notification system in combination with a vaccine screening tool and an educational campaign for families can successfully increase compliance of influenza vaccine administration. These findings are similar to those of previous studies that focus on QI initiatives to improve influenza vaccination rates. By optimizing the influenza vaccine screen in the EMR and implementing triggers within the screening process to accurately identify patients eligible for the influenza vaccine, compliance of vaccine administration improved. Additionally, the success of this process relied on an interprofessional approach. Key factors included collaboration with the IT team in redesigning the influenza vaccine screening tool and creating an automatic text box for physician notification and a focused, multimodal education intervention for nurses and providers.

Project Limitations

Although the EMR facilitated influenza vaccine screening, a subsequent step in which an automatic influenza vaccine order is triggered upon completion of the vaccine screen has not been developed. Provider notification still relied on an automated paging notification requesting an order for the vaccine be placed. This project was a QI initiative designed to evaluate an influenza vaccine screening and administration process within this organization, using a small sample size and EMR rules that were only specific to this system. This poses some limits to the generalizability of the work. Although the SUS survey response rate was low (n=13), 38% of respondents found the usability of the EMR system process for influenza vaccine screening to be highly useful, as indicated by scores greater than 80. However, 54% of respondents had scores of 68 or greater, indicating acceptability of the system, but also suggesting the process steps could be further streamlined to improve ease and efficiency.

Sustainability will require activation of the electronic influenza vaccine screening each flu season. This technologic component decreases missed opportunities and increases flu vaccine rates among high-risk pediatric inpatients. Annual training and commitment of the interprofessional team is also critical to maximize vaccine rates. The incorporation of the text box with automated accessibility to the paging system to notify providers to order influenza vaccines has been embedded in the EMR and furthers the sustainability of this process.