Pharmacist Impact on Pneumococcal Vaccination Rates through Incorporation of Immunization Assessment into Critical Pathways in an Acute Care Setting

Abstract

Despite the availability of effective prevention and treatment measures, pneumococcal infection continues to be a significant source of morbidity and mortality. This study evaluated the impact of incorporating the assessment of pneumococcal vaccination status into selected critical pathways of at-risk patients. In a prospective, nonblinded, parallel-group trial, adult inpatients on four critical pathways were randomized into intervention or control groups. Nursing personnel screened all patients for previous pneumococcal vaccination. A pharmacist would then screen all patients for pneumococcal disease risk factors. If vaccination was indicated in the intervention group, the pharmacist educated the patient and/or caregiver, obtained patient consent, and asked the patient's physician for permission to immunize. No further action was undertaken with the control patients. A total of 231 patients were enrolled in the study (107 intervention, 124 control). Initial immunization rates were 46.8% in the control group and 56.1 % in the intervention group. Forty-six patients in the control group and 39 patients in the intervention group were eligible (unvaccinated with indication) for vaccination. Thirty-two (82.1%) of the patients in the intervention group were counseled and 19 (59.4%) were vaccinated. The overall vaccination rates were 73.8% in the intervention group and 56.1% in the control group (P < 0.001). Results indicate that incorporating assessment of pneumococcal immunization status into critical pathways is an effective way to improve immunization rates.