S54 Improving Influenza and Pneumococcal Vaccination Rates in an Inflammatory Bowel Disease Clinic at Tan Tock Seng Hospital, Singapore

Abstract

Background: Despite a higher risk of infections (such as influenza and pneumococcal disease) with or without immunosuppressive or biologic therapies, vaccination rates remain low among inflammatory bowel disease (IBD) patients in Tan Tock Seng Hospital. Specifically, our 3 months’ retrospective data revealed that ≤15% of patients had completed their influenza and pneumococcal vaccinations. Hence, in January 2021, a team comprising of 3 IBD physicians and 2 new IBD nurses came together to work on a quality improvement (QI) project and streamline the vaccination processes. The primary aim was to improve vaccination rates through a nurse-led vaccination screening, assessment and referral exercise as well as addressing vaccination hesitancy. Methods: A cause and effect QI tool (fish-bone diagram) was adopted to assess and study areas for improvement. Through this root cause analysis, the team was able to identify gaps which contributed to poor vaccination uptake. They included system (unavailability of IBD vaccination protocol, no written education materials for IBD patients, inconvenient vaccination access), physician (limited physician time consult, incomplete vaccination screening or assessment) and patient factors (patient’s perceived lack of benefit, vaccine misconceptions, fear of side effects). In order to address aforementioned factors causing the poor vaccination rates, vaccination guidelines were first protocolised based on national and international clinical guidelines. An information pamphlet was also prepared to help patients better understand the importance and benefits of vaccinations. At each outpatient appointment, IBD nurses would first establish the patient’s vaccination eligibility based on age, disease activity, use of immunosuppressive therapy and vaccination history. Where appropriate, vaccination counselling and pamphlet will be provided to the patient. With patient’s consent, patients would then be referred to the treatment room at the clinic for vaccination administration, all within the same clinical setting. Results: There were 246 patients attended IBD clinic from June to November 2021. Our 6-months post-intervention study reported the following: 1. Clear and systematic vaccination screening and assessment- Vaccination documentation in electronic health records increased from 30% to 100% - a 70% increase compared to pre-intervention 2. Influenza vaccination- 60% of IBD patients fulfilled vaccination eligibility - Influenza vaccination completion increased from 13% to 55% – a 42% increase compared to pre-intervention 3. Pneumococcal vaccination- 28% of IBD patients fulfilled vaccination eligibility - Pneumococcal vaccination completion increased from 2% to 48% - a 46% increase compared to pre-intervention. Conclusion(s): The role of vaccination screening and recommendations were traditionally performed by physicians and pharmacists. However, with the implementation of nurse-led vaccination exercise, it had helped to improve and better identify eligible patients for vaccination in a systematic and concise manner in this one-stop service. It further empowered the 2 new IBD nurses in exercising their clinical judgement skills while freeing up time for physicians to address patients who may have higher medical needs requiring longer consultations. Most importantly, with increasing vaccination rates, IBD patients could be better protected against these vaccines-preventable diseases. We believe that we can achieve higher rates of vaccinations in due time through education and being a vaccine(s) advocate to further reduce vaccine hesitancy.