*Purpose: Streptococcus pneumoniae infections occur in solid organ transplant patients at a rate of 146 per 100,000 persons per year versus 11.5 per 100,000 persons per year in general population. Despite CDC and AST recommendations, studies report suboptimal pneumococcal immunzation in the KT candidates. Our objective was to develop a quality improvement (QI) intervention at Mayo Clinic Florida’s (MCF) Transplant Center to increase the number of KT candidates screened for prior pneumococcal immunizations and improve vaccine adherence.

*Methods: A QI process to improve pneumococcal vaccine adherence in KT candidates at MCF was implemented using Plan-Do-Study-Act (PDSA) methodology. After IRB approval was obtained, data was obtained by retrospective electronic health record review and interventions were designed and implemented over six-week periods based on observed quality gaps. Baseline cohort consisted of patients evaluated for KT at MCF’s transplant center from December 2, 2019-January 14, 2020 baseline. Interventions for PDSA cycle 1 (February 11, 2020-March 25, 2020) and PDSA cycle 2 (August 11, 2020 – September 22, 2020) included sharing baseline data findings enterprise wide, distributing education materials to all ID MCF transplant center staff, and providing ID MCF advanced care practitioners and physicians with a standard pneumococcal vaccine question set to include in their consultation note. Outcomes included documentation rates of prior pneumococcal vaccinations, pneumococcal vaccine order frequency, and Prevnar 13 order completion rate. Data were analyzed using simple descriptive statistics and Pearson’s chi-square.

*Results: Study subjects totaled 214 (baseline n=61, PDSA 1 n=103, PDSA 2 n=50). Pneumococcal immunization history documentation rates improved from baseline 96.7% to 100% post-PDSA cycle 2 (p<0.001). Percentages of patients with a history of Prevnar 13 in baseline, PDSA 1 and PDSA 2 cohorts were 32.8%, 23.3%, and 12.0%, respectively (p<0.001). Percentages of patients with a history of Pneumovax 23 in baseline, PDSA 1 and PDSA 2 cohorts were 32.8%, 34.0%, and 46.0%, respectively (p=0.001). Prevnar 13 and Pneumovax 23 were ordered in the baseline cohort of 92.7% and 100% of patients, respectively. These order rates dropped to 88.6% for Prevnar 13 and 96.8% for Pneumovax 23 post-PDSA likely due to care providers factoring in logistical implications of COVID-19 (p<0.001). Prevnar 13 order completion documentation rates were 41.5%, 38.0%, and 43.6% in baseline, PDSA 1 and PDSA 2 cohorts, respectively (p<0.001).

*Conclusions: The data reflect that improving pneumococcal vaccine adherence in KT candidates is not a simple process and QI requires ongoing effort by all team members. While pneumococcal vaccines were usually ordered by care providers when appropriate, follow-up with patients who chose to complete their vaccines at a site other than MCF remains a gap in care practices.

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