E.K. Joerns, MD, N. Pokala, MD, B. Bermas, MD, P. Bajaj, MD, MPH, Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center;
E.K. Joerns, MD, N. Pokala, MD, B. Bermas, MD, P. Bajaj, MD, MPH, Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center.
J Rheumatol. 2023 Mar;50(3):413-419. doi: 10.3899/jrheum.220771. Epub 2022 Nov 1.
Rheumatology patients are at high risk for complications from pneumococcal infections. The goal of this study was to assess the feasibility of implementing a nurse-driven pneumococcal vaccination protocol based on the 2012 Advisory Committee on Immunization Practices (ACIP) guidelines within an academic rheumatology clinic. Our aims were to increase (1) pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) monthly vaccination rates in immunosuppressed patients aged 19 to 64 years, and (2) the overall proportion of immunosuppressed patients aged 19 to 64 years who have received both PCV13 and PPSV23 vaccinations by ≥ 10% over a 2-year period.
We identified eligible adults in the electronic medical record using a search protocol based on preset medication group. We obtained baseline pneumococcal vaccination rates in 2019, calculating the proportion of patients who were unvaccinated, partially vaccinated (received either PCV13 or PPSV23), or fully vaccinated. We created a pneumococcal vaccination protocol based on 2012 ACIP guidelines and converted it into a standing medical order to be implemented by the nursing staff. Postintervention vaccination rates were calculated monthly and at the end of the study period. Multiple comparison testing was performed to assess for significant postintervention changes.
The average rate of monthly vaccination with either PCV13 or PPSV23 increased from 4.3% in 2019 to 12.6% in 2021. The proportion of patients who were fully vaccinated increased from 14.6% in 2019 to 26.2% in 2021. Both changes were statistically significant.
It is feasible to employ a nurse-driven protocol for improving pneumococcal vaccination rates in immunosuppressed patients, despite difficulties posed by coronavirus disease 2019 (COVID-19) pandemic disruptions.
风湿免疫病患者发生肺炎球菌感染相关并发症的风险较高。本研究旨在评估在学术性风湿免疫门诊中实施基于 2012 年免疫接种实践咨询委员会（ACIP）指南的护士主导型肺炎球菌疫苗接种方案的可行性。我们的目标是：（1）提高 19 至 64 岁免疫抑制患者的肺炎球菌结合疫苗（PCV13）和肺炎球菌多糖疫苗（PPSV23）每月接种率；（2）在 2 年内将 19 至 64 岁免疫抑制患者中至少接种过 1 剂 PCV13 和 PPSV23 的患者比例提高 10%以上。
我们使用基于预设药物组的搜索方案在电子病历中确定符合条件的成年人。我们计算了 2019 年肺炎球菌疫苗接种率，计算未接种、部分接种（接种了 PCV13 或 PPSV23 中的一种）或完全接种的患者比例。我们根据 2012 年 ACIP 指南制定了肺炎球菌疫苗接种方案，并将其转换为由护理人员实施的常规医嘱。每月和研究期末计算干预后的疫苗接种率。采用多次比较检验评估干预后的显著变化。
每月接种 PCV13 或 PPSV23 的平均接种率从 2019 年的 4.3%上升到 2021 年的 12.6%。完全接种患者的比例从 2019 年的 14.6%上升到 2021 年的 26.2%。这两个变化均有统计学意义。
尽管 2019 年冠状病毒病（COVID-19）大流行造成了干扰，但采用护士主导的方案提高免疫抑制患者的肺炎球菌疫苗接种率是可行的。
