PURPOSE: Invasive pneumococcal infection causes significant morbidity and mortality in patients with underlying lung disease. Pneumococcal vaccination has been suggested as a cost-effective means for preventing invasive disease and several organizations recommend vaccination every five years. Eligible COPD patients admitted to Vancouver General Hospital present an opportunity to vaccinate an at-risk population. We therefore conducted a quality improvement project with the aim to increase the rate of pneumococcal vaccinations by 20% in 3 months for eligible patients admitted for an exacerbation.
METHODS: We screened consecutive COPD exacerbation patients admitted to the medicine ward over a seven month period and retrospectively reviewed paper charts and electronic health records to determine pneumococcal vaccine status by the time of discharge. We implemented several plan-do-study-act (PDSA) cycles within this time period: in PDSA 1, we used an existing (but seasonal and underutilized) pneumococcal vaccination form and placed it on the front of eligible patient's charts. The second PDSA cycle involved educating nursing Clinical Management Leaders (CML's) to identify target patients and advocate for vaccination assessment. Our final PDSA cycle involved adding a pneumococcal vaccination assessment tool to the COPD exacerbation pathway.
RESULTS: The overall mean rate of pneumococcal vaccination in eligible COPD patients during the seven months was 40%. Our baseline data showed that 0/12 eligible patients were vaccinated. In PDSA 1, 29% of patients were vaccinated (4/14). In PDSA 2, 45% of patients were vaccinated (5/11) and PDSA 3 had 83% of patients vaccinated (10/12). Run charts by week and by block sampling were created to demonstrate the effects of change over time.
CONCLUSION: We improved the pneumococcal vaccination rate for eligible patients through successive PDSA cycles. Further quality improvement initiatives are required to demonstrate sustainability in the context of a larger sample size.
CLINICAL IMPLICATIONS: Effective interventions for improving vaccination rates involved permanent “champions” in the vaccination assessment stage and adding an assessment tool for pneumococcal vaccination in the COPD pathway. Organizations should look at sustainable options for improving vaccination rates.
DISCLOSURE: Mark Fok, No Financial Disclosure Information; No Product/Research Disclosure Information