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Multifaceted intervention improved influenza vaccination in pediatric cancer cases
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The use of an intervention consisting of technology, education, and clinical process changes effectively increased influenza vaccination uptake in pediatric patients with cancer, according to recent findings.
“Children receiving chemotherapy are at heightened risk of severe influenza infection and resulting complications, including prolonged hospitalization, worse pulmonary complications, and a greater rate of concurrent bacteremia than children without cancer or chronic conditions,” Jason L. Freedman, MD, MSCE, from The Children’s Hospital of Philadelphia, and colleagues wrote. “Although CDC guidelines recommend yearly vaccination in these patients, in our large academic center, less than 60% of oncology patients receiving chemotherapy were immunized at baseline.”
Jason L. Freedman
To increase the rate of vaccination in this population, researchers implemented concurrent interventions in clinical informatics, education and multidisciplinary clinical process interventions at the oncology inpatient unit and three outpatient clinics at The Children’s Hospital of Pennsylvania between Sept. 1, 2012 and March 31, 2013. The program was intended for children aged 6 months or older, had a diagnosis of cancer or stem cell transplant, and had either received chemotherapy in the year before their outpatient visit and/or were at least 100 days from undergoing stem cell transplant.
The interventions included:
- parent/family education, which reminded families about the importance of vaccination;
- clinical informatics, which were retrieved and analyzed from scheduling information for oncology clinics from the EpicCare electronic medical record;
- outpatient clinic initiatives designed to improve the training of clinic support associates who handle patient triage and to assess patients in need of vaccines;
- inpatient intervention, which included orders for influenza vaccination at discharge, if necessary, and
- provider education, including tutorials about the quality improvement efforts presented at conferences, meetings and email circulations. This information pertained to correct ordering of vaccines, documentation of vaccine refusals or doses administered elsewhere, and contraindications to vaccination.
During each study year, most patients exhibited either hematologic or non-central nervous system solid tumor cancers. No significant changes in clinic structure, scheduling practices or physician/nursing staff occurred between study years.
After the interventions, the researchers wrote that complete influenza vaccination rates increased by 20.1% to 64.5%, and the percentage of patients receiving at least one dosage of the vaccination increased by 22.9% to 77.7%. These increases were observed across all types of cancer. Leukemia/lymphoma patients demonstrated the highest rates of vaccination (86.8%); stem cell transplant patients exhibited the lowest rates (66.7%).
“A major component of success here was based on involvement of a diverse care team and continuous involvement of physician and nursing champions in both inpatient and clinic settings, as well as the triage and nursing teams who facilitated communication about the flu and each child’s needs among patients, families, and the providers,” the researchers wrote. “This teamwork, with overlapping process improvements, aided the momentum of the initiative.”
Disclosure: The researchers report no relevant financial disclosures.
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