O-024 Improving Pneumococcal Immunization Rates Among Immunocompromised Adolescent Patients with Inflammatory Bowel Disease

Abstract

BACKGROUND: Streptococcus pneumoniae is a leading cause of severe infections, including pneumonia and meningitis, among immunocompromised patients. The administration of both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated for patients with immunocompromising conditions per U.S. Advisory Committee on Immunization Practices (ACIP) guidelines. The aim of this project was to increase the percentage of immunocompromised patients 11 years and older seen in the Inflammatory Bowel Disease (IBD) clinics at Cincinnati Children's Hospital Medical Center (CCHMC) who receive PCV13 vaccine from less than 5% to 80%. METHODS: Providers from various specialty clinics at CCHMC recognized common barriers related to immunization administration, including knowledge gaps, access to immunization records, identification of the immunocompromised patients, sharing responsibility of vaccine administration between the primary care provider (PCP) and the specialist and the appropriate timing of vaccines. Eligible patients in this project included adolescents defined as immunocompromised according to Center for Disease Control and Prevention (CDC) guidelines, between 11 and 18 years of age, who were seen in the IBD clinics between February and July 2015. Interventions that were implemented during the project included development of a process to obtain immunization records from the PCP, education of clinic providers by a colleague from the Infectious Disease Department (ID), education of the IBD nurse coordinators and the clinic medical assistants; the development of physician "talking points" for patients; easy clinic access to vaccines and pre-clinic "huddles," that included a visual reminder for the medical assistant and a pended order for the vaccine. Additionally, a post visit letter was sent to the PCP identifying the patient as immunocompromised and the need for additional vaccines outside of the established well-child immunization schedule along with next steps. RESULTS: During the project, 136 eligible patients were seen in IBD clinics. The pre-intervention immunization rate for PCV13 was near zero. In total, 117 (86%) of those eligible received the PCV13. At the initiation of the project, most failures were related to not identifying the patient as needing the vaccine and the preference to receive the vaccine in the PCP's office. With the institution of the pre-clinic huddle and utilizing the provider "talking points," the main reason for failure at the end of the project was a request to defer the vaccine to a later visit with the specialist. CONCLUSIONS: We have demonstrated that with a few key interventions, it is possible to increase the PCV13 vaccination rate to over 80% in an outpatient clinic setting for immunocompromised patients with IBD. These same measures can be easily implemented in other clinics for different vaccinations and chronic conditions. Two additional clinics that manage patients with chronic illness (Rheumatology and HIV) have instituted similar interventions, adapting for clinic workflow, with similar results.