*Purpose: Solid organ transplant (SOT) recipients are at increased risk of influenza infection and severe influenza-related complications. The influenza vaccine is a safe and effective means of preventing influenza and its attendant complications in SOT recipients but rates of vaccination in this population have historically been quite low. In this single center retrospective study, we evaluated the impact of a nurse-driven order protocol for influenza vaccines on rates of vaccination in abdominal SOT recipients.

*Methods: Our medical center is a 600 bed tertiary care center that provides all major medical services, including comprehensive organ transplantation services. A nurse-driven influenza vaccine order protocol, which enabled nurses to administer the influenza vaccine without specific authorization from a licensed independent provider, was implemented in October 2014 across all clinical sites, both ambulatory and inpatient. This protocol applied to SOT recipients as well as the general patient population. We compared rates of influenza vaccination in abdominal SOT recipients during all influenza seasons from 2011 through 2017. An individual abdominal SOT recipient was counted in the denominator for each influenza season that occurred after the date of transplant. The pre-protocol period was defined as influenza seasons 2011-2014 and the post-protocol period was defined as influenza seasons 2014-2017. Vaccination status was determined by chart review.

*Results: 631 abdominal SOT recipients were included in the study. Influenza vaccination rates in this population during the pre-protocol influenza seasons of 2011-2012, 2012-2013, and 2013-2014 were 54.1%, 47.0%, and 47.6% respectively. Influenza vaccination rates in this population during the post-protocol influenza seasons of 2014-2015, 2015-2016, and 2016-2017 were 72.2%, 69.3%, and 66.7% respectively. The average influenza vaccination rate for the three post-protocol influenza seasons increased 19.8% over that for the three pre-protocol influenza seasons (69.4% versus 49.6%, P=0.002).

*Conclusions: Our data demonstrate that implementation of a nurse-driven order protocol throughout a hospital system improved influenza vaccination rates in a particularly vulnerable population, abdominal SOT recipients. This simple, cost-effective protocol significantly improved our transplant program’s adherence to guideline recommendations for influenza vaccination in SOT recipients and could easily be adapted for implementation in transplant programs nationwide.

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