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Improving Influenza Vaccination in Hospitalized Children With Asthma
Dana M Foradori1, Esther M Sampayo2, S Aya Fanny2
1Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas foradod@ccf.org.
Insights
Influenza vaccination rates for hospitalized children with asthma increased from 13% to 57% over four years. Interventions included electronic health record modifications and nurse-driven protocols, improving vaccination during hospitalization.
Area of Science:
- Pediatric hospital medicine
- Infectious disease prevention
- Asthma management
Background:
- Children with asthma face higher risks from influenza.
- Hospitalization offers a key opportunity to administer influenza vaccines.
- The study focused on increasing vaccination rates in this vulnerable pediatric population.
Purpose of the Study:
- To significantly increase the influenza vaccination rate among eligible children with asthma hospitalized on the pediatric hospital medicine service.
- The target was to raise the vaccination rate from 13% to 80% over a four-year period.
Main Methods:
- Implementation of serial Plan-Do-Study-Act cycles to drive improvements.
- Modifications to the electronic health record (EHR), provider/family education, and a hospital-wide tracking tool.
- Development of an institutional, nurse-driven vaccine protocol by a multidisciplinary team.
Main Results:
- The inpatient influenza vaccination rate rose from 13% to 57% over four years, achieving special cause variation.
- Fifty percent of eligible patients received the vaccine during hospitalization post-intervention.
- Documentation of vaccination status improved significantly (51% to 96%), with no adverse events reported.
Conclusions:
- A comprehensive bundle of interventions effectively increased influenza vaccination rates in hospitalized children with asthma.
- Key components included EHR enhancements, education, and a nurse-driven protocol.
- The study demonstrated a successful strategy for improving vaccine uptake in a high-risk pediatric group.
Objectives:
Children with asthma are at increased risk of complications from influenza; hospitalization represents an important opportunity for vaccination. We aimed to increase the influenza vaccination rate among eligible hospitalized patients with asthma on the pediatric hospital medicine (PHM) service from 13% to 80% over a 4-year period.
Methods:
Serial Plan-Do-Study-Act cycles were implemented to improve influenza vaccination rates among children admitted with status asthmaticus and included modifications to the electronic health record (EHR) and provider and family education. Success of the initial PHM pilot led to the development of a hospital-wide vaccination tracking tool and an institutional, nurse-driven vaccine protocol by a multidisciplinary team. Our primary outcome metric was the inpatient influenza vaccination rate among PHM patients admitted with status asthmaticus. Process measures included documentation of influenza vaccination status and use of the EHR asthma order set and a history and physical template. The balance measure was adverse vaccine reaction within 24 hours. Data analysis was performed by using statistical process control charts.
Results:
The inpatient influenza vaccination rate increased from 13% to 57% over 4 years; special cause variation was achieved. Overall, 50% of eligible patients were vaccinated during asthma hospitalization in the postintervention period. Documentation of influenza vaccination status significantly increased from 51% to 96%, and asthma history and physical and order set use also improved. No adverse vaccine reactions were documented.
Conclusions:
A bundle of interventions, including EHR modifications, provider and family education, hospital-wide tracking, and a nurse-driven vaccine protocol, increased influenza vaccination rates among eligible children hospitalized with status asthmaticus.
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