International Journal of COPD (Nov 2019)

Improving Influenza Vaccination Coverage Among Patients With COPD: A Pilot Project

  • Li A,
  • Chan YH,
  • Liew MF,
  • Pandey R,
  • Phua J

Journal volume & issue
Vol. Volume 14
pp. 2527 – 2533

Abstract

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Andrew Li,1 Yiong-Huak Chan,2 Mei Fong Liew,1,3 Rakshya Pandey,4 Jason Phua1,3 1Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore; 2Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore; 4Department of Respiratory Medicine, Ng Teng Fong General Hospital, National University Health System, SingaporeCorrespondence: Andrew LiYong Loo Lin School of Medicine, National University of Singapore Division of Respiratory and Critical Care Medicine, National University Hospital, NUHS Tower Block, Level 10 5 Lower Kent Ridge Road, 119228 SingaporeEmail [email protected] and objective: Guidelines for chronic obstructive pulmonary disease (COPD) advocate regular influenza vaccination, which has been shown to reduce exacerbations. However, influenza vaccination rates remain low. This quality improvement project was initiated to help improve influenza vaccination rates in a tertiary hospital.Methods: All patients with COPD in the airway program (TAP) in the National University Hospital at the end of 2013 were recruited. The interventions were implemented in 2014; thus, population was stratified into the pre-intervention group and post-intervention group. Those who died in 2014 were excluded. They were (1) patient education posters in the clinics on the need for regular influenza vaccination, (2) direct interventions by physicians, and (3) intervention by the nurses when vaccinations were neglected. Physicians were made aware of previous vaccination rates, vaccination card reminders were placed in the clinics, and a new electronic healthcare record system (EHR) was implemented. The patients were followed up till the end of 2015 or until death. When an influenza vaccination was administered, the patients were asked which of the interventions led to the vaccination. A questionnaire was delivered to the physicians to determine the interventions that led to any change in vaccination prescription practices.Results: The pre-intervention influenza vaccination rate was low at 47.7%. The post-intervention influenza vaccination rate improved to 80.7% with the multi-pronged approach. Physicians initiated the majority of vaccinations (87.9%), while nurses helped intervene in a further 12.1%. Physicians’ vaccination prescription practices changed as a result of self-awareness of low vaccination rates, vaccination card reminders, and the new EHR. Patient education made minimal impact.Conclusion: This project demonstrates that with regular audits to track progress and several easy-to-implement interventions, improving influenza vaccination rates is an achievable goal.Keywords: influenza vaccination, quality improvement project, COPD  

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