Reindel Kristin, Rightmier Elizabeth, Dean Julie S, Qualls Brandon W, Wawrzyniak Julie
Department of Pharmacy (KR, ER, JW), University of Rochester Medical Center, Rochester, NY, USA.
Department of Neurology (JSD), University of Rochester Medical Center, Rochester, NY, USA.
Int J MS Care. 2023 Mar-Apr;25(2):71-74. doi: 10.7224/1537-2073.2021-127. Epub 2022 Sep 26.
It is recommended that patients taking immunosuppressive anti-CD20 monoclonal antibodies (mAbs) receive pneumococcal vaccinations before their first dose to ensure optimal immune response. An initial medication use evaluation reviewed adherence to Centers for Disease Control and Prevention (CDC) pneumococcal immunization recommendations at the study site, and room for improvement was identified. The nursing team implemented workflow changes to increase nursing involvement in vaccination coordination, education, tracking, and administration. We sought to evaluate the impact of a nursing intervention on optimal pneumococcal vaccination administration rates in patients receiving anti-CD20 mAbs at a multiple sclerosis (MS) center.
We performed a single-center, retrospective, pre/post medication use evaluation. Inclusion criteria were older than 18 years with a diagnosis of MS and received their first anti-CD20 mAb infusion at the study site during the preintervention or postintervention time frame.
We included 406 and 73 patients in the preintervention and postintervention studies, respectively. The nursing intervention significantly improved the percentage of patients receiving optimal pneumococcal vaccination before their first infusion from 58% to 84% and significantly reduced the number with unknown vaccination status from 17% to 3%. Patients who received optimal follow-up vaccination with 23-valent pneumococcal polysaccharide vaccine after optimal 13-valent pneumococcal conjugate vaccine administration improved from 9% to 56%.
A nursing team intervention improved adherence to CDC pneumococcal immunization recommendations for patients receiving anti-CD20 mAb therapy. This project highlights the value of interdisciplinary team collaboration between health system specialty pharmacies and specialized nursing teams in the care of patients with MS.
建议服用免疫抑制性抗CD20单克隆抗体（mAb）的患者在首次给药前接种肺炎球菌疫苗，以确保获得最佳免疫反应。一项初始用药评估审查了研究地点对疾病控制与预防中心（CDC）肺炎球菌免疫接种建议的依从性，并确定了改进空间。护理团队实施了工作流程变更，以增加护理人员在疫苗接种协调、教育、跟踪和给药方面的参与度。我们试图评估一项护理干预措施对一家多发性硬化症（MS）中心接受抗CD20 mAb治疗的患者实现最佳肺炎球菌疫苗接种率的影响。
我们进行了一项单中心、回顾性、干预前/后用药评估。纳入标准为年龄大于18岁，诊断为MS，且在干预前或干预后时间段内在研究地点接受首次抗CD20 mAb输注。
我们在干预前和干预后研究中分别纳入了406例和73例患者。护理干预显著提高了首次输注前接受最佳肺炎球菌疫苗接种的患者比例，从58%提高到84%，并显著降低了疫苗接种状态未知的患者数量，从17%降至3%。在最佳接种13价肺炎球菌结合疫苗后接受最佳23价肺炎球菌多糖疫苗后续接种的患者比例从9%提高到56%。
护理团队干预提高了接受抗CD20 mAb治疗患者对CDC肺炎球菌免疫接种建议的依从性。该项目凸显了卫生系统专科药房和专业护理团队之间跨学科团队合作在MS患者护理中的价值。
