Evaluation of a Pharmacy-to-Dose Pneumococcal Vaccination Protocol at an Academic Medical Center

Abstract

Background: In February 2016, a pharmacy-to-dose (PTD) pneumococcal vaccination protocol was implemented to aid in the appropriate selection of pneumococcal vaccines. Objective: The primary objective was to compare the rate of appropriate vaccine ordering with the PTD protocol. Secondary objectives were to assess vaccine administration rate and determine factors preventing patients from receiving the vaccine after appropriate selection. Methods: This was a single-center, retrospective cohort study of adult patients admitted to an inpatient service. Eligible patients were 19 years of age or older and had either a PTD pneumococcal vaccination order placed or an alert triggered indicating that the patient was a candidate for a vaccination. Patients were excluded if they had contraindications to receiving either pneumococcal vaccine. The Fisher exact test was used to evaluate the primary objective, and descriptive statistics were used to evaluate the secondary objectives. Results: A total of 327 patients were included in the analysis: 167 in the preprotocol cohort and 160 in the postprotocol cohort. The correct vaccine ordering rates were found to be 26.9% (45/167) and 83.1% (133/160) in the preprotocol and postprotocol cohorts, respectively ( P < 0.001). In the postprotocol cohort, 17.5% (28/160) of patients did not have a vaccine administered. Reasons for vaccine administration failure were identified as patient refusal, patient expired during admission, vaccine not dispensed by pharmacy, and vaccine dispensed by pharmacy but returned. Conclusions: The PTD pneumococcal vaccination protocol significantly improved correct vaccine ordering rates.