Fletcher Meghan, Rankin Shannon, Sarangarm Preeyaporn
The University of New Mexico, Health Sciences Center, Albuquerque, USA.
Hosp Pharm. 2019 Feb;54(1):45-50. doi: 10.1177/0018578718769239. Epub 2018 Apr 18.
Tetanus vaccinations for wound prophylaxis are routinely administered in emergency departments (ED). Current recommendations from the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) regarding tetanus administration for wound prophylaxis differentiate between the tetanus and diphtheria (Td) and the tetanus, diphtheria, acellular pertussis (Tdap) formulations and when they should be administered. Lack of knowledge regarding these recommendations, different formulations, and techniques to locate patient immunization history can lend to increased duplicate and inappropriate vaccinations. The purpose of this prospective, interventional study with a historical control was to evaluate the impact of a pharmacy-driven education series on the proportion of duplicate and inappropriate tetanus vaccinations administered in a level I trauma center ED. Three months of tetanus vaccinations administered in the ED after this education were analyzed and compared with a historical control. The primary outcome is the percentage of vaccinations considered duplicates (previous vaccination within the past 5 years) when patients' medical record was reviewed for immunization history. Secondary end points include the percentage of vaccinations considered nonadherent (according to current CDC-ACIP guidelines), the total cost of all duplicate vaccinations, and the percentage of vaccination orders that had the wrong formulation administered. The percentage of duplicate vaccinations decreased from 9.9% (25 vaccinations) to 5.5% (14 vaccinations) (P = .067) from the preintervention group to the postintervention group. Nonadherent vaccinations compiled 3.6% versus 2.8% of the vaccinations (P = .611) and incorrect formulations given were 18.2% versus 11.4% (P = .176) in the preintervention and postintervention groups, respectively. The study suggests that multiple formulations of tetanus vaccinations and fragmented documentation of immunizations increase the prevalence of medication errors related to tetanus vaccinations. It also indicates that interventions more enduring than education are required to prevent these errors.
急诊科（ED）通常会进行破伤风疫苗接种以预防伤口感染。疾病控制与预防中心（CDC）以及免疫实践咨询委员会（ACIP）目前关于破伤风疫苗接种以预防伤口感染的建议，区分了破伤风和白喉（Td）疫苗以及破伤风、白喉、无细胞百日咳（Tdap）疫苗制剂，以及它们的接种时机。由于对这些建议、不同制剂以及查找患者免疫史的技术缺乏了解，可能会导致重复接种和不适当接种的情况增加。这项具有历史对照的前瞻性干预研究的目的是评估由药房主导的教育系列对一级创伤中心急诊科重复和不适当破伤风疫苗接种比例的影响。对此次教育后急诊科三个月内的破伤风疫苗接种情况进行了分析，并与历史对照进行比较。主要结果是在查看患者病历以了解免疫史时，被视为重复接种（过去5年内曾接种过）的疫苗接种百分比。次要终点包括被视为不符合接种要求（根据当前CDC - ACIP指南）的疫苗接种百分比、所有重复接种的总费用，以及接种了错误制剂的疫苗接种订单百分比。从干预前组到干预后组，重复接种的百分比从9.9%（25次接种）降至5.5%（14次接种）（P = 0.067）。不符合接种要求的疫苗接种在干预前组和干预后组分别占疫苗接种的3.6%和2.8%（P = 0.611），接种错误制剂的比例分别为18.2%和11.4%（P = 0.176）。该研究表明，破伤风疫苗的多种制剂以及免疫记录的不完整增加了与破伤风疫苗接种相关的用药错误发生率。研究还表明，需要比教育更持久的干预措施来预防这些错误。
