Guideline-driven Initiative Improves Pneumococcal Vaccination Rates Among aHSCT Recipients

A nurse-led team developed a tracking tool that created a vaccination schedule from transplant date forward for autologous hematopoietic stem cell transplant recipients.
A nurse-led team developed a tracking tool that created a vaccination schedule from transplant date forward for autologous hematopoietic stem cell transplant recipients.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

Denver, CO — A guideline-driven tracking tool; a template for provider progress notes, including data points in the EHR; and a standardized re-immunization “entry” at 6 and 12 months can effectively ensure autologous hematopoietic stem cell transplant (aHSCT) recipients receive the recommended posttransplant vaccinations, a study presented at the 2017 Oncology Nursing Society Annual Congress has shown.

Influenza-associated pneumonia rates are significantly higher among HSCT recipients than in the general population (7% to 35% vs 2% to 8%, respectively). This difference underscores the importance of immunizations in mitigating vaccine-preventable diseases in this patient population.

Guidelines from the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the European Group of Blood and Marrow Transplantation recommend serial re-immunizations on recovery from aHSCT (full reconstitution of the immune system takes 1 to 4 years). Initial recommended vaccines are seasonal influenza, pneumonococcal, and haemophilus influenza B conjugated vaccines, administered within the first 6 months.

On assessment of our community-based program, however, less than 40% of aHSCT recipients received their initial pneumococcal vaccine within 1 year post-aHSCT, with less than 60% of those patients completing the series, explained Carole Elledge, DNP, RN, AOCN, of Methodist Hospital in San Antonio, Texas. The existing order for re-immunization was not representative of current guidelines.

Therefore, Elledge and colleagues sought to design an intervention to improve vaccination rates among aHSCT recipients. The multifaceted intervention was designed to systematically assess vaccine readiness and track serial vaccine administration.

The intervention is comprised of 4 components: a tracking tool delineating transplant date with recommendations for all post-aHSCT vaccinations as well as vaccines administered to date for clinicians to review prior to the patient visit; an “IMMUNIZATIONS” field in the clinician dictation template, intended to trigger an assessment of vaccine eligibility; initial and ongoing education for the clinical staff regarding vaccine indications following aHSCT; and a redesigned workflow that alerted staff of vaccinations due at follow-up visits.

The researchers evaluated 61 patients for vaccine eligibility at 180 and 365 days following aHSCT during a prescheduled long-term follow-up clinic visit between August 11, 2016, and November 10, 2016.

Pneumococcal vaccination rates among eligible aHSCT recipients were improved to 100%. In addition, the vaccination rate among aHSCT recipients who are not eligible was reduced to 0%.

In the future Elledge and colleagues seek to track provider coverage and co-pays, postimmunization titers, and measure to VPIs prospectively. The researchers also plan to pilot a posttransplant vaccine readiness algorithm and immune reconstitution testing in aHSCT recipients at 6 and 12 months posttransplant.

Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.

REFERENCE

1. Elledge C, Rush B, Cordell T, Sowan A. A quality improvement initiative to increase pneumococcal vaccination rates following allogeneic hematopoietic stem cell transplantation. Oral presentation at: Oncology Nursing Society 42nd Annual Congress; May 4-7, 2017; Denver, CO.

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