368 Doan Hall, 410 W. 10th Avenue, Columbus, OH 43210, United States; The Ohio State University Wexner Medical Center, United States.
Center for Biostatistics, 320-43 Lincoln Tower, 1800 Cannon Drive, Columbus, OH 43210, United States; The Ohio State University Wexner Medical Center, United States.
Res Social Adm Pharm. 2018 Apr;14(4):367-371. doi: 10.1016/j.sapharm.2017.04.013. Epub 2017 Apr 24.
Asplenic patients are at increased risk for post-splenectomy infection caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B (Hib), and vaccination rates against these organisms remain low. The purpose of this study was to evaluate vaccination rates before and after implementation of a pharmacist-driven electronic vaccination tracking system.
This retrospective cohort analysis compared adult splenectomy patients before and after implementation of a pharmacist-driven tracking system with a primary outcome of complete initial vaccination. The system included use of an i-Vent to track and communicate vaccination status and a bundled vaccination order set. Complete initial vaccination was defined as documented administration of the following vaccines: pneumococcal, meningococcal, and Hib. Secondary outcomes included complete follow-up vaccination and factors associated with incomplete vaccination.
A total of 261 patients were included for analysis (142 pre-intervention, 119 post-intervention). The most common indication for splenectomy was malignancy (52.1% pre-intervention, 47.9% post-intervention). Complete initial vaccination rates increased by almost 10% post-intervention from 68.3% to 77.3% (p = 0.11). There was a statistically significant increase with guideline recommended pneumococcal (13-valent) as part of the initial vaccination series (p < 0.001).
Implementation of a pharmacist-driven electronic vaccination tracking system and bundled order set may increase rates of vaccination among asplenic patients. Although this improvement was not statistically significant, it is still clinically impactful. One limitation of the study was many outpatient oncology pharmacists were not utilizing the tracking tool at the time of data collection. Projected vaccination rates are likely higher now that more pharmacists are aware of this tool.
由于肺炎链球菌、脑膜炎奈瑟菌和乙型流感嗜血杆菌（Hib），无脾患者在脾切除术后感染的风险增加，而这些病原体的疫苗接种率仍然很低。本研究的目的是评估实施药剂师驱动的电子疫苗接种跟踪系统前后的疫苗接种率。
这项回顾性队列分析比较了在实施药剂师驱动的跟踪系统前后的成人脾切除术患者，主要结局是初始完全疫苗接种。该系统包括使用 i-Vent 来跟踪和沟通疫苗接种状况以及捆绑的疫苗接种医嘱集。完全初始疫苗接种定义为记录了以下疫苗的接种：肺炎球菌、脑膜炎球菌和 Hib。次要结局包括完全随访疫苗接种和与不完全疫苗接种相关的因素。
共纳入 261 例患者进行分析（干预前 142 例，干预后 119 例）。脾切除术最常见的指征是恶性肿瘤（干预前为 52.1%，干预后为 47.9%）。干预后初始完全疫苗接种率从 68.3%增加到 77.3%，几乎增加了 10%（p=0.11）。初始疫苗接种系列中建议使用 13 价肺炎球菌疫苗（p<0.001）有统计学意义的增加。
实施药剂师驱动的电子疫苗接种跟踪系统和捆绑医嘱集可能会提高无脾患者的疫苗接种率。尽管这种改善没有统计学意义，但仍然具有临床意义。该研究的一个局限性是，在数据收集时，许多门诊肿瘤药师并未使用该跟踪工具。现在，由于更多的药师了解到了这一工具，预计疫苗接种率会更高。
