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Utilizing Information Technology to Improve Influenza Vaccination in Pediatric Patients With Inflammatory Bowel
Darla Shores1, Lindsay Wilson, Maria Oliva-Hemker
1Darla Shores, MD, Department of Pediatrics, Gastroenterology, Hepatology & Nutrition, Johns Hopkins Children's Center, Baltimore, MD. Lindsay Wilson, MSN, RN, CPNP, Department of Pediatrics, Gastroenterology, Hepatology & Nutrition, Johns Hopkins Children's Center, Baltimore, MD. Maria Oliva-Hemker, MD, Department of Pediatrics, Gastroenterology, Hepatology & Nutrition, Johns Hopkins Children's Center, Baltimore, MD.
Insights
Pediatric inflammatory bowel disease patients are often undervaccinated. Implementing electronic medical record prompts and involving gastroenterology nurses significantly improved influenza vaccination rates and counseling in this vulnerable population.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Influenza vaccination rates are suboptimal in pediatric patients with inflammatory bowel disease (IBD).
- Gastroenterology nurses are well-positioned to enhance vaccination uptake in this high-risk group.
- Improving influenza immunization is crucial for preventing severe illness in immunocompromised children.
Purpose of the Study:
- To assess the effectiveness of electronic medical record (EMR) prompts in boosting influenza vaccination among pediatric IBD patients.
- To evaluate the impact of gastroenterology nurse involvement on vaccination documentation and counseling.
- To measure changes in influenza vaccination rates over a two-year implementation period.
Main Methods:
- A quality improvement project utilizing customized EMR prompts was implemented.
- Influenza vaccination documentation was tracked at baseline, Year 1, and Year 2.
- Vaccine counseling rates for unvaccinated patients were recorded.
- Outcomes were compared between patients seen by gastroenterology nurses and those seen by physicians alone.
Main Results:
- Influenza vaccination documentation increased from 10% at baseline to 61% by Year 2 (p < .001).
- Vaccine counseling for unvaccinated patients rose from 27% to 77% by Year 2 (p < .001).
- Patients seen by gastroenterology nurses showed higher vaccination/counseling rates (94%) compared to physician-only visits (70%) by Year 2 (p < .001).
Conclusions:
- Customized EMR prompts are effective in improving influenza vaccination documentation in pediatric IBD patients.
- Gastroenterology nurse-led interventions significantly enhance vaccination rates and counseling.
- Integrating IT prompts and nursing support is a viable strategy for improving preventive care in specialty pediatric clinics.
Abstract:
Pediatric patients with inflammatory bowel disease are undervaccinated against influenza. Gastroenterology nurses are ideally situated to assist in improving vaccination in this population. The objective of this quality improvement project was to evaluate the implementation of information technology prompts within the electronic medical record to improve influenza vaccination during specialty clinic visits. The proportion of patients with yearly influenza vaccination was evaluated at baseline, Year 1, and Year 2 following implementation. At baseline, only 10% of a random sample had documented influenza vaccination. Vaccination documentation improved to 39% (96/246) by Year 1 and to 61% (175/287) by Year 2 (p < .001). Vaccine counseling improved from 27% to 77% by Year 2 for unvaccinated patients (p < .001). Among patients seen by gastroenterology nurses, the proportion of patients with either documented vaccination or counseling was 94% by Year 2 compared with 70% if seen only by a physician (p < .001). Documentation of influenza vaccination improved with the use of customized prompts. Patients seen by a gastroenterology nurse had higher vaccination documentation and vaccine counseling than those who were seen by a physician alone.
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