Previsit Planning Improves Pneumococcal Vaccination Rates in Childhood-Onset SLE

• Published in: Pediatrics (Evanston) 2020-01, Vol.145 (1), p.1
• Main Authors: Sivaraman, Vidya, Wise, Kelly A, Cotton, William, Barbar-Smiley, Fatima, AlAhmed, Ohoud, MacDonald, Darby, Lemle, Stephanie, Yildirim-Toruner, Cagri, Ardoin, Stacy P, Ardura, Monica I
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Age Factors; Age of Onset; Algorithms; Autoimmune diseases; Child; Children; Electronic Health Records; Electronic medical records; Female; Health Plan Implementation; Health Services Accessibility; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Infections; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - drug therapy; Male; Morbidity; Nursing Staff; Outcome Assessment, Health Care; Patient Care Team - organization & administration; Pediatrics; Pharmacists; Pneumococcal Infections - microbiology; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - immunology; Polysaccharides; Practice Guidelines as Topic; Quality control; Quality Improvement; Streptococcus infections; Systemic lupus erythematosus; Vaccination - statistics & numerical data; Vaccination - trends; Vaccines; Vaccines, Conjugate - administration & dosage; Vaccines, Conjugate - immunology; Young Adult
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2018-3141

Childhood-onset systemic lupus erythematosus (c-SLE) is a complex autoimmune disease that requires systemic immunosuppressive therapy. Infections are the second leading cause of death in these patients, with invasive pneumococcal infections being a major preventable cause of morbidity and mortality. Pneumococcal vaccination is recommended in this population; however, vaccination rates remain low. The plan-do-study-act method of quality improvement was applied. We calculated baseline vaccination rates for pneumococcal conjugate and pneumococcal polysaccharide vaccines in patients with c-SLE in the rheumatology clinic from January 2015 to August 2016. We developed an age-based algorithm to simplify the vaccination guidelines. The clinical pharmacist and nurses performed weekly previsit planning to update vaccine records, make targeted recommendations, and ensure vaccine availability. The primary outcome measure was the percentage patients with of c-SLE seen per month who had received age-appropriate pneumococcal vaccination. The percentage of children receiving at least 1 pneumococcal vaccine increased from 24.9% to 92.7% by 12 months. By 18 months, the compliance rate with both pneumococcal vaccines increased from 2.5% to 87.3%, with sustained results. No serious adverse events or disease flares were reported. By identifying the major barriers to pneumococcal vaccination in our population with c-SLE, we significantly improved vaccination rates while decreasing time burden on providers. We attribute our success to a team-based quality improvement approach and plan to implement alerts in the electronic health record to streamline the process.