Strides Toward Improving Post-Hematopoietic Progenitor Stem Cell Transplant Vaccination Compliance.

Topic Significance & Study Purpose/Background/Rationale Hematopoietic stem cell transplant (HCT) recipients are at risk for losing natural and acquired immunities, that can lead to post-HCT infectious complications. Post-HCT re-vaccination is considered a standard of care by FACT and NMDP. The current work is a quality improvement project to improve vaccination compliance. Programmatic deficiencies were identified and a Plan Do Study Act (PDSA) was implemented. Methods, Intervention, & Analysis A retrospective audit of recipient charts was performed for vaccination schedule completion and compliance by September 30, 2016. The audit is a snapshot of patients that have received vaccines at the scheduled intervals or completed the full vaccination schedule. Compliance was defined as completion of scheduled vaccination within 3 months of target date unless otherwise documented. Relapse, delayed, held for GVHD/immunosuppressant's or steroids, and refusal with proper documentation are considered complaint. Deceased patients within 3 months of target date were excluded. Overall compliance is defined as: at the 24-month landmark, which patients have received vaccinations at all landmarks based on the compliance guidelines. 21-months after implementing the PDSA, recipient charts were audited for vaccination schedule completion and compliance by June 30, 2018. Findings & Interpretation Identified deficiencies included an infrastructure that did not allow for vaccinations to be given in the same clinic as the patient's appointment with their transplant physician, lack of communication between the clinics, inconsistent orders and documentation, and a lack of knowledge with staff and patients. The PDSA interventions included a standardized vaccination order sheet, appointment identification, staff and patient education, reminder cards, and policy updates. After implementing the PDSA, the overall compliance has increased from 56.7% to 72% and overall completion has increased from 76% to 83.8% over a 21-month period. Discussion & Implications Vaccination compliance requires standardization of practices, effective communication, and adequate documentation when caring for post-transplant patients. Success of a post transplantation vaccination program requires unwavering commitment to provide support and oversight for effective vaccination strategies. Retrospective vaccination chart audits continue quarterly to achieve an 80% compliance rate. [ABSTRACT FROM AUTHOR]