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Abstract: PO2007

Pneumococcal Vaccination in High-Risk Pediatric Nephrology Patients

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Gefen, Ashley M., Cohen Children's Medical Center, Queens, New York, United States
  • Basalely, Abby Miriam, Cohen Children's Medical Center, Queens, New York, United States
  • Balamohan, Archana, Arkansas Children s Hospital, Little Rock, Arkansas, United States
  • Frank, Rachel, Cohen Children's Medical Center, Queens, New York, United States
  • Moravec, Megan, Cohen Children's Medical Center, Queens, New York, United States
  • Fassano, Jessica, Cohen Children's Medical Center, Queens, New York, United States
  • Rajan, Sujatha, Cohen Children's Medical Center, Queens, New York, United States
Background

Children with nephrotic syndrome (NS), chronic kidney disease (CKD) and immunosuppression (IS) are at high risk of invasive pneumococcal infection but are often under-vaccinated with PCV13 and PPSV23. We aimed to increase vaccination rates in high-risk pediatric nephrology (PN) patients from <10% to 75% by 2022.

Methods

Process measures of vaccine rates (percent of eligible patients monthly that received vaccines) were evaluated over 3 years. Initially, a designated nurse and fellow checked electronic medical records (EMR), Citywide Immunization Registry (CIR) and pediatrician records. PPSV23 was administered in PN clinic. A driver diagram was created to determine sources of improvement and 3 PDSA cycles were completed.

Results

374 patients (20% up-to-date (UTD), 5% missing PCV13, 32% missing PPSV23, 34% missing both) were identified. Sources of failure to vaccinate with initial interventions were single stakeholder reliance, lack of follow-up and vaccine supply. Primary drivers were patient identification, vaccine administration and rate determination. All physicians and nurses were taught to identify patients, check vaccine history and use a vaccine algorithm. Study of our interventions revealed unanticipated obstacles with monetary cost, vaccine refusal and shared responsibility. To aid monetary issues a new stakeholder (manager) was created. Vaccines were re-offered at subsequent visits if initially refused. Reminders were sent to physicians on the importance of patient identification in clinic. Vaccination increased to >75% and has been sustained for 4 months (Figure 1). Percent UTD increased to 39%.

Conclusion

Incorporating and educating multiple stakeholders and adequate vaccine access improved vaccination rates at our center. Our methods appear successful without excess time expenditure. Further study is underway to ensure sustainability without excess monetary cost.

Figure 1: Run chart