Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Pediatrics. 2020 Mar;145(3). doi: 10.1542/peds.2019-1735.
Children with asthma are at increased risk of complications from influenza; hospitalization represents an important opportunity for vaccination. We aimed to increase the influenza vaccination rate among eligible hospitalized patients with asthma on the pediatric hospital medicine (PHM) service from 13% to 80% over a 4-year period.
Serial Plan-Do-Study-Act cycles were implemented to improve influenza vaccination rates among children admitted with status asthmaticus and included modifications to the electronic health record (EHR) and provider and family education. Success of the initial PHM pilot led to the development of a hospital-wide vaccination tracking tool and an institutional, nurse-driven vaccine protocol by a multidisciplinary team. Our primary outcome metric was the inpatient influenza vaccination rate among PHM patients admitted with status asthmaticus. Process measures included documentation of influenza vaccination status and use of the EHR asthma order set and a history and physical template. The balance measure was adverse vaccine reaction within 24 hours. Data analysis was performed by using statistical process control charts.
The inpatient influenza vaccination rate increased from 13% to 57% over 4 years; special cause variation was achieved. Overall, 50% of eligible patients were vaccinated during asthma hospitalization in the postintervention period. Documentation of influenza vaccination status significantly increased from 51% to 96%, and asthma history and physical and order set use also improved. No adverse vaccine reactions were documented.
A bundle of interventions, including EHR modifications, provider and family education, hospital-wide tracking, and a nurse-driven vaccine protocol, increased influenza vaccination rates among eligible children hospitalized with status asthmaticus.
患有哮喘的儿童患流感并发症的风险增加；住院治疗是接种疫苗的重要机会。我们的目标是在 4 年内将儿科住院医学（PHM）服务中符合条件的因哮喘急性发作而住院的患者的流感疫苗接种率从 13%提高到 80%。
通过连续的计划-执行-研究-行动循环来提高因哮喘急性发作而入院的儿童的流感疫苗接种率，其中包括对电子健康记录（EHR）和医护人员及家属教育的修改。PHM 试点项目的初步成功导致了一种全院范围的疫苗跟踪工具的开发和一种由多学科团队制定的医院内、护士驱动的疫苗方案。我们的主要结果衡量指标是因哮喘急性发作而入住 PHM 病房的患者的住院流感疫苗接种率。过程指标包括流感疫苗接种状况的记录以及 EHR 哮喘医嘱集和病史及体检模板的使用。平衡措施是 24 小时内的不良疫苗反应。数据分析通过使用统计过程控制图进行。
在 4 年内，住院流感疫苗接种率从 13%提高到 57%；特殊原因变异得到实现。总体而言，在干预后期间，50%的符合条件的患者在哮喘住院期间接种了疫苗。流感疫苗接种状况的记录显著增加，从 51%增加到 96%，并且哮喘病史和体检以及医嘱集的使用也得到了改善。没有记录到不良的疫苗反应。
一整套干预措施，包括 EHR 修改、医护人员和家属教育、全院范围的跟踪以及护士驱动的疫苗方案，提高了因哮喘急性发作而住院的符合条件的儿童的流感疫苗接种率。
