Impact of the Introduction of a Vaccination Status Checkbox in Electronic Medical Records on Pneumococcal Vaccination Rates

IntroductionElectronic health records have been widely introduced into clinical practice. The aim of this study was to determine whether a small interface change could improve compliance with a key quality indicator, namely antenatal pertussis vaccination.MethodsAudits were performed between 1–31 July 2015 and 1–31 July 2017 of all deliveries at the Centenary Hospital for Women and Children to determine compliance with antenatal pertussis vaccination. The single difference between time points was changing the interface so the antenatal pertussis vaccination field became compulsory.Results275 and 299 women delivered in the audit periods. Vaccination rates almost doubled (52.7% vs 91.4%, p<0.0001).ConclusionSmall interface changes increase compliance. Interface change could be considered for key quality outcomes in patient care.

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Increasing Pneumococcal Vaccination Rates Among Hospitalized Patients

Infection Control and Hospital Epidemiology ◽

10.1086/502240 ◽

2003 ◽

Vol 24 (7) ◽

pp. 526-531 ◽

Cited By ~ 20

Author(s):

Mary Patricia Nowalk ◽

Donald B. Middleton ◽

Richard K. Zimmerman ◽

Mary M. Hess ◽

Susan J. Skledar ◽

...

Keyword(s):

Nursing Staff ◽

Medical Center ◽

Pneumococcal Infection ◽

Pneumococcal Vaccination ◽

Vaccination Status ◽

Quality Improvements ◽

Post Intervention ◽

Record Keeping ◽

Vaccination Rates ◽

Standing Order

AbstractObjective:To increase the proportion of inpatients vaccinated against pneumococcal infection.Design:Pre- and post-intervention study.Setting:University medical center–affiliated, suburban community teaching hospital.Patients:Unvaccinated inpatients 65 years and older and those 2 to 64 years old who had chronic medical conditions predisposing them to invasive pneumococcal infection.Intervention:The nursing staff screened newly admitted patients for eligibility based on age, diagnosis, or medications from a computer-generated admissions list and placed a pre-printed order form for the pneumococcal polysaccharide vaccine (PPV) on the charts of eligible patients. Following the physician's order, the nursing staff administered the PPV and recorded it. Ongoing quality improvements including admission vaccination screening and computer-based record keeping were initiated to identify unvaccinated eligible patients and track vaccination status.Results:Efforts resulted in rates of in-hospital vaccination ranging from 3.1% to 7.9% (mean, 5.2% ± 1.7% [standard deviation]) and significant improvements in the assessment of previous vaccination status, reaching 54% of eligible patients after 1 year. Ascertainment of a previous vaccination increased significantly following the initiation of the use of admission forms that specifically assessed vaccination status and a system to permanently record vaccination status in an electronic medical record (P < .05).Conclusion:Concerted efforts using electronic medical records significantly improved the assessment and documentation of inpatient vaccination status. Greater improvement of the rates of in-hospital vaccination will require healthcare system–wide efforts such as a standing order policy for vaccinating all eligible patients. Standing orders for inpatient immunization supported by effective assessment and tracking systems have the potential to raise vaccination rates to the goals of Healthy People 2010 (Infect Control Hosp Epidemiol 2003;24:526-531)

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Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study

RMD Open ◽

10.1136/rmdopen-2020-001499 ◽

2021 ◽

Vol 7 (1) ◽

pp. e001499

Author(s):

Uta Kiltz ◽

Aylin Celik ◽

Styliani Tsiami ◽

Bjoern Buehring ◽

Xenofon Baraliakos ◽

...

Keyword(s):

Rheumatic Diseases ◽

Pneumococcal Vaccination ◽

Latent Tuberculosis ◽

Cross Sectional Study ◽

Study Data ◽

Vaccination Status ◽

Inflammatory Rheumatic Diseases ◽

Cross Sectional ◽

Vaccination Rates ◽

Vaccination Recommendations

ObjectiveTo evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD).MethodsConsecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0–26) categorising patients into four immunisation states: low (0–6), moderate (7–13), good (14–20), high (21–26).ResultsAll patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score.ConclusionsThe majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.

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P003 An audit of the uptake of vaccinations against influenza, pneumonia and varicella zoster among rheumatology outpatients

Rheumatology ◽

10.1093/rheumatology/keab247.002 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Khalid Kazi ◽

Audrey Low

Keyword(s):

Demographic Data ◽

Pneumococcal Vaccination ◽

Clinic Visit ◽

Vaccination Status ◽

British Society ◽

Electronic Patient Records ◽

Varicella Zoster ◽

Vaccination Rates ◽

Vaccination Uptake ◽

Influenza Pneumonia

Abstract Background/Aims Patients with autoimmune inflammatory rheumatic disease (AIIRD) requiring disease modifying anti rheumatic drugs (DMARDs) are at risk from influenza, pneumonia and shingles but vaccination rates have been low (∼70%). This audit aimed to evaluate vaccination uptake (aim 90% uptake) amongst those eligible and to assess whether the departmental vaccination advice was included in the standard letter template irrespective of the timing of the vaccination programmes. Methods 213 rheumatology outpatient clinic appointments were identified between 3 to 7 February 2020. Exclusions were 56 new patients or non-attenders, 31 patients who were neither treated with DMARDs nor had a diagnosis of AIIRD and 17 patients with AIIRD who did not need vaccination. The remaining 109 patients were eligible for vaccination according to Public Health England, British Society for Rheumatology and the European Alliance of Associations for Rheumatology (EULAR) guidelines. Electronic patient records (hospital and GP) were accessed for demographics, clinical data, vaccination status for influenza for the winter of 2019/20, pneumococcus and varicella zoster. Additionally clinic letters from the week of the audit were audited as a snapshot to identify whether the departmental vaccination advice was included within the standard letter template. Results The majority of the patients were female (65%) with rheumatoid arthritis (37%); a third was ≥65 years old (Table 1). 22 of the 109 patients in whom influenza and pneumococcal vaccination were indicated did not have a vaccination status available in their GP records. 63 and 61 of the remaining 87 patients were appropriately vaccinated against influenza and pneumococcus respectively (72% and 70%). Vaccination data were available for all 12 patients in whom Zostavax was indicated; 7 patients were appropriately vaccinated (64%). Only 24 out of 126 (19%) clinic letters included the departmental vaccination advice. P003 Table 1:Demographic data of patients eligible for vaccinationDemographic dataN = 109Female, N (%)71 (65)Median age (IQR), yrs57 (47-70)Age categories (%), yrs- 18-4933 (3)- 50-6441 (38)- ≥6535 (32)Rheumatological Diagnosis, N (%)Rheumatoid Arthritis40 (37)Psoriatic Arthritis15 (14)Ankylosing Spondylitis10 (9)Myositis3 (3)Systemic Sclerosis11 (10)Vasculitis9 (8)Systemic lupus erythematosus2 (2)Other Inflammatory Arthritis14 (13)Other Inflammatory Rheumatological Condition5 (5)Significant Co-Morbidities, N (%)Respiratory23 (21)Cardiovascular19 (17)Renal9 (8)Hepatic10 (9)Neurological1 (1)Diabetes Mellitus11 (10)Immunological5 (5)Obesity BMI >402 (2)Rheumatological Medication prescribed as the time of clinic visit, N (%)Any Biologic or Non Biologic DMARD85 (78)Any Biological DMARD38 (35)Any Non Biological DMARD67 (62)- Methotrexate34 (31)- Hydroxychloroquine20 (18)- Sulfasalazine14 (13)- Leflunomide2 (2)- Other Non Biological DMARD10 (9)Oral Corticosteroids27 (24) Conclusion Rates of vaccination were low and in line with previous studies. For the 2020/21 winter, the department is writing directly to patients to advise influenza vaccination. The standard letter template will be changed to include the vaccination advice in all letters. The department will re-audit vaccination uptake after these interventions. Disclosure K. Kazi: None. A. Low: None.

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