Analysis of Vaccination Rates of 23-Valent Pneumococcal Polysaccharide Vaccine after Quality Improvement Project in Hospitalized Patients with Diabetes Mellitus

Abstract

Introduction: Since 2014, the American Academy of Pediatrics has recommended that patients over two years with diabetes mellitus (DM) receive the 23-valent pneumococcal polysaccharide vaccine (PPSV23). Methods: Retrospective chart review was initiated by a quality improvement (QI) project to determine PPSV23 administration rates for inpatients with DM at Children's Hospital of Orange County (CHOC). The QI project included education for staff and families regarding need for PPSV23 in patients with DM. Electronic medical record (EMR) order sets for DM were updated with PPSV23 vaccine. Data were collected from EMR to identify differences in subjects who were vaccinated with PPSV23 and unvaccinated from April 2015 to April 2016. Results: Before April 2015, PPSV23 was not being given to inpatients with DM. There were 199 individual subjects admitted to CHOC with DM from April 2015 to April 2016. Of those, 78 subjects (39.1%) received vaccine. Data were categorized to identify if vaccine was ordered (n = 152) or not (n = 47). Univariate logistic regression analysis performed on whether PPSV23 was ordered showed age, location (pediatric intensive care unit [PICU] vs. floor), hemoglobin A1c (HbA1c), primary DM admission, and insulin pump vs. injection usage were significant factors (P < 0.05). Multivariate logistic regression showed that those with higher HbA1c (P = 0.014), new-onset DM (P = 0.009), and those admitted for primary DM-related issues (P = 0.007) were more likely to have PPSV23 ordered. No significant subject factors identified differences in why vaccine was not administered (n = 74) once ordered. Conclusion: PPSV23 rates for pediatric inpatients with DM increased from 0% to 39% during one year following education and EMR modifications.

Pediatric Inpatient Immunizations: A Literature Review

“…39 In addition to the influenza vaccine, 2 studies were focused on pneumococcal polysaccharide vaccination in special populations. 40,41 In 1 study, nursing-driven assessments and standing orders were used to increase vaccination in children who were hospitalized with risk factors as well as in adults who were hospitalized at their institution; in the second study, staff education and EMR order sets were used for patients with diabetes mellitus, and both led to increased inpatient immunization rates by 15% and 43%, respectively. 40,41 Through these studies, lessons were learned that may better inform further interventions.…”

“…40,41 In 1 study, nursing-driven assessments and standing orders were used to increase vaccination in children who were hospitalized with risk factors as well as in adults who were hospitalized at their institution; in the second study, staff education and EMR order sets were used for patients with diabetes mellitus, and both led to increased inpatient immunization rates by 15% and 43%, respectively. 40,41 Through these studies, lessons were learned that may better inform further interventions. Increased involvement and empowerment of the nursing staff was frequently cited in successful programs, and multiple studies relied on a nurse coordinator or on nursing-driven protocols to improve vaccine uptake.…”