Increasing influenza and COVID-19 vaccination assessment rate in medical oncology clinics at a safety-net hospital.
Authors: Semlow Andrea R. , Delgado Iza , Spannagel Tennesse , Sadeghi Navid , Mohamed Ashraf , Moran Brett , Hodges Mary P , Cobb Robyn , Dickerson Umber 
Published: October 2023

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Background: Vaccination against influenza and COVID-19 have been shown to reduce the risk of severe infection and adverse outcomes in immunocompromised individuals such as cancer patients. Consistent and accurate immunization assessment is the first step to identify patients who could benefit from these vaccines. The CDC Standards for Adult Immunization Practices recommend a vaccine assessment at every clinical encounter to ensure patients benefit from the latest recommendations. This process improvement project aims to increase COVID-19 and influenza vaccination assessment rate in new medical oncology patients within 2 weeks of their initial visit from a baseline of 6.1% - measured between 08/15/22 and 12/02/22. Methods: Parkland Health (PH) is the safety-net system for Dallas County, TX with an average of 2300 new cancer cases, of whom almost half are uninsured, and the majority belong to the racial/ethnic minorities. After mapping the assessment process and a root cause analysis, the multidisciplinary project team recommended a set of interventions with the goal to improve the assessment rate to 50%. The first PDSA cycle developed assessment policies and procedures, as well as group/individual training for clinic nurses. In the second PDSA, the weekly aggregate assessment rate was reviewed in safety huddles and a SmartPhrase was developed to document the immunization assessment in the after-visit summary (AVS). In the 3rd PDSA cycle, the immunization assessment tab was moved to nursing visit navigator in the electronic medical records (EMR) to streamline nursing assessment functions. This project is supported by the ASCO Quality Training Program and funded by the CDC/CMSS. Results: The first PDSA cycle resulted in a significant increase in vaccination rate, reaching 73.9% by week 4 (6-week average 51.9%). The second PDSA cycle resulted in the 5-week average rate increasing to 67.7%. A chart audit (included 25% of cases) showed that in 86.2%, patient’s vaccination was not up to date; however, the SmartPhrase was used in only 3.4% cases to document this in the AVS. Partial data (4-weeks) for the 3rd PDSA cycle shows an increase in average immunization assessment rate to 76.2%. In a post-intervention survey (response rate= 40.5%; 15), RNs estimated that the new immunization assessment added 1-5 minutes to their patient care time. In addition, 78.6% agreed/strongly agreed that the immunization assessment was an important part of their job, and 71.4% agreed/strongly agreed that the current process meets their expectations. Conclusions: Our interventions resulted in a consistent increase in immunization assessment for our new patients with minimal impact on clinic nurses’ time. In our next steps, we plan to further streamline the process across all patients (new and established). The ultimate goal of this project is to facilitate a high immunization rate among our cancer patients.