100 - Optimizing pneumococcal vaccination in children with nephrotic syndrome

Poster Number: 100
Publication Number: 100.138

Jennifer Fishbein, Boston Children's Hospital, Boston, MA, United States; Avram Traum, Boston Children's Hospital, Boston, MA, United States; Michael Somers, Boston Children's Hospital, Boston, MA, United States; Nina Mann, Boston Children's Hospital, Boston, MA, United States

Background: Children with nephrotic syndrome are at increased risk for invasive pneumococcal infections. In addition to the pneumococcal conjugate vaccine (PCV13) series, they should also receive the 23-valent pneumococcal polysaccharide (PPSV23) vaccine. Since PPSV23 is not part of standard childhood vaccine schedules, its availability in ambulatory settings is limited, complicating its provision to this at risk population.

Objective: We aimed to use quality improvement (QI) practices to increase the rate of PPSV23 vaccination in children with nephrotic syndrome followed in our program.

Design/Methods: We developed a QI project composed of sequential PDSA cycles to implement a process for PPSV23 vaccination for children with idiopathic nephrotic syndrome seen in the pediatric nephrology clinic from 2019 through 2021. Key drivers for this initiative included access to valid immunization records, proactive identification of children requiring vaccination, vaccine availability in pediatric nephrology clinic, multidisciplinary team engagement, patient and family education, and communication with primary care practices. Our PDSA cycle interventions were (1) to standardize a process to obtain up-to-date vaccination records and to contact the primary nephrologist and primary care physician for children needing vaccination; (2) to educate providers on rationale for this project and to target changes to administrative, nursing, and clinician workflow; and (3) to standardize our pre-visit screening workflow and optimize opportunity for vaccination in nephrology clinic. The overall PPSV23 vaccination rate for children with nephrotic syndrome seen in clinic was tracked monthly.

Results: Baseline PPSV23 vaccination rates were 8.3%. After the first PDSA cycle, in June 2019, the vaccination rate increased to 13% and by the end of the second cycle in July 2020, the vaccination rate increased to 36.8%. After the interventions from the third PDSA cycle were implemented, the vaccination rate increased to 79.5% in December 2021. There was an average of 26 nephrotic children seen each month during this three-year project.Conclusion(s): Using QI strategies, we increased PPSV23 vaccination rates 10-fold in children with nephrotic syndrome. Successful intervention required staff education and buy in, workflow changes for multiple stakeholders, and implementation of a standardized workflow of pre visit screening and planning. Opportunities for future PDSA cycles include facilitating access to out-of-state vaccine records, automation of pre visit screening, and determining better strategies to vaccinate children seen by virtual visit.