Increasing pneumococcal vaccinations for patients with lung cancer

Abstract

<p>Pneumococcal vaccinations are recommended for patients with lung cancer either before or during treatment to prevent pneumonia. During oncology care, infectious complications contribute to treatment interruptions, poor outcomes, and increased hospitalizations and healthcare expenditures. Pneumococcal vaccination rates remain well below the benchmarks set by Healthy People 2020 despite support from the Centers for Disease Control and Prevention (CDC) and the National Comprehensive Cancer Network (NCCN). A quality improvement (QI) project was implemented within a thoracic medical oncology practice utilizing the 4PillarsTM Practice Transformation Program to increase both the frequency of immunization assessment and the pneumococcal vaccination rate. Intervention implementation and prospective data collection occurred over an 8-week timeframe applying the Plan-Do-Study-Act (PDSA) model and the Diffusion of Innovations (DOI) theoretical framework. Thoracic oncologists were given educational resources on pneumococcal vaccinations and the electronic medical record&rsquo;s (EMR) immunization workflow. Informational posters were displayed at the check-in desk and clinic rooms for patients to read. An EMR alert was proposed by this author and denied by the information technology (IT) staff; without an alert to prompt immunization assessment during clinic visits, the onus was on the oncologists or patients to initiate discussion about pneumococcal vaccinations. Despite the educational resources and reminders, there was no appreciable increase in vaccination rates during the brief QI project. Some providers noted improved awareness of the EMR immunization workflow, however, sustained behavior change takes time and requires ongoing support and reinforcement. Likewise, implementing an EMR alert during oncology visits would ensure consistent vaccination assessment and immunization. Keywords: lung cancer, pneumococcal vaccination, pneumonia, quality improvement</p>