Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Kerry A. Milner, DNSc, APRN, FNP-BC, EBP-C
Practice Mentor
Cecelia Calhoun, MD
Abstract
Background
Sickle cell disease (SCD) is the most common inherited blood disorder worldwide, predominately affecting vulnerable and underserved populations. Due to functional asplenia, individuals with SCD are immunocompromised and vulnerable to invasive pneumococcal diseases, including fatal sepsis. Adults with SCD have a life expectancy that is 30-35 years shorter than the U.S. average, highlighting a critical gap in preventative care and the urgent need to improve vaccination efforts.
Project Goals
Ensure on-site availability of pneumococcal vaccination during clinic visits.
- Increase pneumococcal vaccination rates among eligible adults with sickle cell disease.
- Increase provider recommendation of pneumococcal vaccination during visits.
Methods
This quality improvement project was guided by the RE-AIM framework to support systematic implementation and evaluation of on-site pneumococcal vaccination and provider education in an adult SCD clinic. Interventions focused on reach (identifying vaccine-eligible patients), effectiveness (increasing discussions and uptake), adoption (provider engagement), implementation (workflow integration), and maintenance (process sustainability). Plan–Do–Study–Act cycles were used to conduct small tests of change, refine workflows, and address barriers during rollout. Aggregate monthly clinic data were analyzed pre- and post-implementation.
Results
In June 2025, prior to implementation, 86 patients were seen in clinic; 36 were vaccine eligible, with no documented vaccine discussions and no vaccines administered. Following implementation in October 2025, 54 patients were seen in clinic; 38 (70%) were vaccine eligible, 25 (65.8%) had vaccine discussions, and 13 (52.6%) were vaccinated. In November 2025, 68 patients were seen in clinic, 42 (61.7%) were vaccine eligible, 32 (76.2%) had discussions, and 20 (61.9%) were vaccinated.
Conclusion
Integration of provider education and on-site vaccine availability significantly improved pneumococcal vaccination rates among adults with sickle cell disease. Improving vaccination uptake in this population helps reduce the risk of invasive pneumococcal disease, a potentially fatal complication. This combined strategy can be applied in other clinical settings to improve vaccination coverage and prevent avoidable infectious outcomes.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Cole, J. (2026). Improving pneumococcal vaccination in adults with sickle cell disease through on-site vaccination and provider education: a quality improvement project [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.