O2135: Standardizing an Inpatient Vaccination Administration Process at a Large Free-standing Pediatric Hospital

Purpose/Objectives: The purpose of this quality improvement initiative is to augment vaccination uptake in our community at-large by standardizing an inpatient vaccination administration process for hospitalized children. There is significant variability in vaccine administration practices across US children's hospitals. Current estimates have cited 27-84% of hospitalized children are vaccine-eligible and the majority do not receive their age-appropriate vaccinations prior to discharge resulting in missed opportunities. When offered during hospitalization, most caregivers accept vaccinations for their children. Our goal was to implement a standard process to vaccinate children discharged from our Pediatric Hospital Medicine (PHM) services, thereby decreasing missed opportunities. Our objective for this initiative was to increase the number of patients vaccinated on three PHM services by 50% over two years after standardizing an inpatient vaccination process.

Design/Methods: We formed a multidisciplinary team in Spring 2020 and utilized the plan-do-study-act (PDSA) quality improvement methodology to implement a standard inpatient vaccination process beginning July 1, 2020. Pharmacists reviewed vaccine status at hospital admission and notified medical teams. Using a family-centered approach, medical teams discussed administration of overdue vaccines and addressed vaccine-hesitancy. Nursing teams administered vaccines and provided counseling. The four-year study period includes a two-year baseline (July 1, 2018 - June 30, 2020) and two-year intervention (July 1, 2020 - June 30, 2022) period. We included patients discharged from three PHM services and tracked eight pediatric vaccines. Descriptive data was analyzed using Microsoft Excel.

Results: Of the eight vaccines studied on a sample of three PHM services, 75 patients received vaccines during the baseline period (1.2%) compared to 107 patients during the intervention period (2.4%); a 43% increase in patients vaccinated. The average annual census was 2303 patients (range: 1949-2532). We found the greatest increase in adolescent vaccines (HPV, Meningitis, TDaP), then under 12-month vaccines (DTaP, Hep A), and the least for one-year vaccines (Hep B, MMR, Varicella). We are in the process of analyzing all ACIP recommended pediatric vaccines including combination vaccinations, remaining PHM service teams, and patient demographics.

Conclusion/Discussion: Following process implementation in patients discharged from the hospitalist service, we have seen a 43% increase in patients vaccinated based on preliminary data analysis. Implementing a standardized inpatient vaccine process in a large free-standing hospital is complex and challenging; evidence-based strategies to overcome system-level barriers to standardizing vaccine administration are still needed. Future PDSA cycles will include improving data collection processes to capture the number of vaccine-eligible patients, follow rates of missed opportunities, enhance data integration with multiple state central databases, and follow process and balancing measures to improve standardization. Other planned areas of study include addressing disparities in vaccine administration and developing methods to improve vaccine confidence.