Improving documented rates of comprehensive vaccination status assessment and vaccination recommendation in patients receiving chemotherapy at a breast medical oncology clinic.

431 Background: The National Adult and Influenza Immunization Summit (NAIIS) promoted clinical subspecialist efforts toward vaccination assessment and recommendation as one strategy to increase adult vaccination rates. Problem Statement: Between August 1, 2022, and May 31, 2023, 0% (n=0/100) of patients seen in medical oncology at Mayo Clinic (Rochester, MN) and receiving chemotherapy for breast cancer had a documented comprehensive vaccination status assessment by breast medical oncology staff. Aim Statements: (1) To increase the rate of comprehensive vaccination status assessment performed by breast medical oncology staff from 0% to 75% of patients receiving chemotherapy for breast cancer by September 2024. (2) To increase the rate of documented vaccination recommendation for patients who were not up to date with recommended vaccinations from 0% to 50% by September 2024. Methods: We deployed multiple interventions including physician and nurse education; development of patient education materials; and a standard operating procedure (SOP) for vaccination status assessment, vaccination recommendation, and vaccine-related documentation. Our SOP utilized an Epic SmartPhrase with following elements: (1) SmartLink that autopopulated overdue vaccinations, (2) hidden tip text permitting the use to hyperlink to Health Maintenance, (3) SmartLists that captured nurse actions (e.g., provided education) and encounter outcomes (e.g., patient endorsed plans to receive vaccinations), and (4) scripting for immunization education. Results: Multi-faceted interventions were associated with an improvement in the documented rate of comprehensive vaccination status assessment from 0% (n=0/100) to 82.8% (n=101/122). Most patients (77.2%, n=78/101) were not up to date with recommended vaccinations. Recommendations for appropriate vaccinations were made for 80.8% (n=63/78) of patients who were not up to date. Only 19.2% (n=15/78) of patients who were not up to date endorsed intention to receive missing/recommended vaccines. Counterbalance: Nurses were able to assess vaccination status and make appropriate recommendations in less than 5 minutes per patient. There was no difference in nurse-reported workflow burden related to vaccination status assessment, recommendation, or documentation after intervention. Conclusions: This quality project aligned our breast medical oncology practice with vaccination-related care promoted by NAIIS. We increased rates of vaccination status assessment and vaccination recommendations without impacting nurse-reported workflow burden. Medical subspecialty clinic engagement in vaccination efforts is feasible.