BI24 Documentation of vaccination status in healthcare records for patients who attended dermatology systemic clinic
Authors: Yong Ji Fung , McFeely Orla , Griffin Laoise , Cozman Anita , Cummins Emmet , O’Connell Michael , Durack Alana , Paul Lyndsey 
Published: June 2024

Abstract
The British Association of Dermatologists (BAD) has recommended that patients treated with immunosuppressive medicines receive influenza and pneumococcal vaccines prior to commencement of treatment and booster injections in conjunction with systemic therapy. Patients prescribed systemic therapy for chronic inflammatory skin conditions are likely to contract vaccine-preventable infections due to the immunosuppressive nature of these medications. Hence, it is important to educate patients regarding the benefit of vaccinations and to document vaccination status while reviewing this cohort. The first cycle of audit is to review documentation of vaccination status for immunosuppressed patients attending dermatology follow-up as recommended by the BAD Biologics Checklist. Healthcare records of patients who attended the dermatology systemic clinic for a 4-week period were reviewed, specifically looking for documentation of influenza, COVID-19 booster and pneumococcal vaccination status. Overall, 102 medical records were reviewed over a 4-week period. Vaccination status was clearly documented in 79.6% (n = 81) of medical records. Of the 21 charts with no documentation of vaccination status, vaccination advice was documented in 7 charts as part of the management plan. Three patients were recorded as vaccine hesitant without any clear reason documented. With departmental agreement, a checklist consisting of the influenza vaccine status, COVID-19 booster status, pneumococcal vaccine status and cervical smear status was created and printed on a label. With the help of nursing staff, the printed label with the checklist was attached to patients’ clinical notes as a reminder for dermatology physicians to enquire about patients’ vaccination status. Healthcare records of patients who attended the dermatology systemic clinic over a 4-week period were reviewed after implementation of change as the second cycle of this audit, specifically looking for completion of the checklist. As part of this cycle, 126 medical records were reviewed over a 4-week period. The checklist was completed for 85.7% (n = 108) of medical records. Five (4%) of the remaining charts (n = 18) had vaccination status clearly documented in writing. Thirteen charts (10.3%) had no vaccination status documented in printed labels or in writing. The rate of documentation of vaccination status after the intervention was 89.7% as compared with 79.6% in the first audit cycle. From a medicolegal perspective, the process of assessing patients’ vaccination status has not occurred unless the outcome is clearly documented in the medical notes. Dermatologists are encouraged to assess and document the vaccination status of patients attending systemic clinic follow-up as recommended by the BAD guidelines. Printed checklist labels have been proven to be an effective way to ensure clear documentation. The printed label will also serve as a prompt for dermatologists to encourage the uptake of vaccines in high-risk groups.