Customized electronic alerts to boost pneumococcal vaccinations in high risk cancer patients.

Abstract

e18227 Background: Streptococcus pneumoniae remains a leading cause of serious illness, including bacteremia, meningitis, and pneumonia among adults in the United States. Approximately 10% of all patients with invasive pneumococcal disease die of their illness, but case-fatality rates are higher for immunocompromised adults including cancer patients. Current Center for Disease Control (CDC) guidelines recommend routine use of 13-valent (Prevnar 13) and 23-valent (Pneumovax 23) pneumococcal vaccines (PV) for immunocompromised patients. We conducted a quality improvement (QI) project utilizing our electronic medical record (EMR) system to improve PV compliance (PVC) rates in our patients. Methods: We created automatic reminders called best practice alerts (BPA) and linked them to a smart order set within our EMR that appeared upon opening patient charts. The smart set ordered the correct vaccine in sequence based on CDC guidelines. From August 2015- January 2017, we implemented this BPA for one of six hematology providers and the remaining providers were provided with verbal guidelines and reminders to administer PV to their patients. Results: At baseline only 22% of 3000 hematology patients within the practice had received PV. The pilot provider with the BPA linked to a smart order set within the EMR improved PVC within his patients from 23% to 66%. Providers who were just given verbal guidelines improved PVC from an average of 22% to 45%. The difference in the improvement between the pilot provider and the reference group is 21% (p < 0.001). Conclusions: In an EMR era, we took advantage of the tools within our system to improve PVC rates. BPA linked to a smart order set within the EMR provided better means of improving PVC than verbal prompts in high-risk immunocompromised patients. Additionally, the increase in PVC throughout the hematology practice is due to primary care providers using similar reminders within the same EMR. The PV BPA will be conducted as a standard of care in our clinic and will be expanded to oncology patients as well.

Quality Improvement Interventions to Enhance Vaccine Uptake in Cancer Patients: A Systematic Review

“…In total, 13 studies were analyzed for this review. [13][14][15][16][17][18][19][20][21][22][23][24][25]…”

“…17,21 One intervention involving electronic medical records built the influenza vaccine order into the admission order, 13 whereas another tied a best practice alert to the pneumococcal vaccine order set. 21 Another study at an oncology clinic placed an influenza vaccination prescription in patients' charts during their visit. Each of the five studies incorporated other interventions and each study saw a notable increase in vaccination rates.…”

“…Three studies examined interventions involving guidelines for vaccines. 15,19,21 Wong et al 15 recommended timing for providers to vaccinate during therapy and Draliuk et al 19 developed a standard operating procedure, or step-by-step instructions, for vaccinations of patients in their cohort. Bhatt et al provided verbal guidelines to their hematologists and found that best-practice alerts were more effective in increasing vaccine uptake.…”

“…Our review encountered several limitations. Most significantly, the diverse nature of interventions in Bhatt et al 21 Chang et al 23 Orders for vaccines 5 Freedman et al 13 Wong et al 15 Grivas et al 17 Bhatt et al 21 Chang et al 23 Guidelines for vaccinations 3 Wong et al 15 Draliuk et al 19 Bhatt et al 21 Adding a healthcare worker 3 Wong et al 15 Delacruz et al 18 Rostamnjad et al 20 Systems level Improving vaccine availability 3 Freedman et al 13 McGinnis et al 14 Lee et al 22 Nurse-led vaccine clinic 1 Harper et al 25 the studies prevented us from undertaking a metaanalysis. Our reliance on published studies may bias our findings toward positive outcomes, because studies with negative results are less frequently published.…”

Effect of Electronic Health Record Reminders for Routine Immunizations and Immunizations Needed for Chronic Medical Conditions

“…Other investigators have, for example, reported the need for more specific alerts specifying whether the PCV13 versus PPSV23 immunization is due to improve the chances that providers would act on CDS for children with kidney transplants. 30 Others have also developed immunization alerts for a specific medical condition 31 or to recommend the influenza immunization for children with CMCs 32 ; however, we are not aware of investigators who have developed an alert that encompasses multiple CMC-related immunizations and numerous CMCs.…”