Achieving optimal vaccine administration in a pediatric cochlear implant program after implementation of a Quality Improvement Project

Objectives: To maximize vaccination compliance in children undergoing cochlear implantation and thus minimize meningitis-related complications. To present a Quality Improvement (QI) Project for 23-valent pneumococcal polysaccharide vaccine (PPSV-23) administration within a pediatric cochlear implant program.

Methods: We identified children from birth through 21 years of age with cochlear implants or cochlear implant candidates who were seen at Children's Health Medical Center/UT Southwestern Medical Center, Dallas between 12/2018 and 01/2020. Protocols were developed for physicians and nurses using electronic medical record (EMR) smart phrases with prompts to review and document vaccine status and plan. Charts were reviewed for six consecutive cycles of 6-12 weeks for vaccine documentation and plan compliance. Regular feedback was provided to physicians and nurses. A cochlear implant EMR registry was developed for increased surveillance of vaccine administration.

Results: Physicians and nurses showed an improvement in vaccine documentation from the start of the project to the first data cycle review (61%-90% and 20%-91% for physicians and nurses respectively). This was followed by a regression in the third to fourth review cycles (decrease to 67% and 80% compliance). Vaccine documentation compliance improved after subsequent review and feedback, and peaked during the final cycle of the review (83% and 100% compliance). During the year-long QI project, one child with a cochlear implant missed the PPSV-23 vaccine but was identified during cycle review and vaccinated. This occurred during the third cycle, and for the remaining three cycles there were no missed vaccinations. On completion of the QI project, a formal vaccination oversight program was introduced with a physician/nurse team that reviews the cochlear implant EMR registry monthly for children who have not been vaccinated. In the 13 months since the completion of the QI project there has been 100% compliance with no children who missed vaccination.

Conclusion: We present a vaccination program with oversight to address missed vaccinations. Implementation of a QI project followed by transition to a formal vaccination oversight program eliminated missed PPSV-23 vaccinations in children with cochlear implants. We recommend that cochlear implant programs use similar approaches to ultimately minimize potential meningitis-related complications in patients with cochlear implants.