Barriers and Facilitators of Inpatient Vaccine Delivery at US Children's Hospitals: A Qualitative Study

Despite many hospitalized children missing recommended vaccines, vaccines are rarely administered during hospitalization. Our objective was to explore the key determinants for inpatient vaccine delivery in a sample of 11 US children's hospitals.

We used the Pediatric Health Information System database to identify children's hospitals in the Pediatric Research in Inpatient Setting network who were in the top tertile (n = 6) and the bottom tertile of inpatient vaccine administration (n = 5). We recruited pediatric nurses, pharmacists, and hospitalists to participate in semistructured interviews. Interview questions were based on the Consolidated Framework for Implementation Research and focused on current practices and barriers to inpatient vaccine delivery. Interviews were conducted via telephone or teleconferencing and were recorded and transcribed. Two reviewers independently coded transcripts using thematic analysis; a third reviewer resolved discrepancies, as needed.

We conducted 36 interviews: 10 hospitalists, 14 nurses, and 12 pharmacists. Several themes emerged as key determinants for inpatient vaccine delivery, including the following: 1) timing: vaccine administration happened predominately at discharge, which at times jeopardized vaccine delivery; 2) access: vaccinating during hospitalization was particularly important when children had difficulty accessing primary care or when traditional health care services were disrupted, eg, during the COVID-19 pandemic; and 3) workflow: vaccine-related workflow is often not standardized and lacks ownership.

Despite variability in vaccine administration across children's hospitals, there are many common barriers and determinants. Solutions that address these barriers and meet the needs of multidisciplinary clinicians are essential to improve inpatient vaccine delivery.