Impact of a pharmacy student-based inpatient pneumococcal vaccination program

American Journal of Pharmaceutical Education, Fall 2001 by Dodds, Elizabeth S, Drew, Richard H, May, D Byron, Gouveia-Pisano, Julie Ann, Et al

Pneumococcal disease remains a significant cause of morbidity and mortality in the adult, at-risk population. Even with the availability of a safe and effective vaccine and well-defined guidelines for its administration, less than half of eligible individuals have been vaccinated. Vaccination programs conducted by pharmacists have been proposed and proven effective in helping to expand vaccine coverage. We conducted an inpatient pneumococcal vaccination program that was carried out by Doctor of Pharmacy candidates completing Internal Medicine rotations. Twenty-eight students screened 785 patients at four different medical centers throughout North Carolina. As a result of the student screening process 134 patients received the pneumococcal vaccine, increasing our vaccination rate from 38 percent on admission to 57 percent at the time of hospital discharge. This benefit was seen with little resource commitment from the faculty and institutions involved. Pharmacy students can be a valuable resource in improving vaccination rates on an inpatient basis, benefiting student, institution and patients.

INTRODUCTION

Pneumococcal disease accounts for nearly 40,000 deaths annually(l). Despite the availability of a safe and effective vaccine to prevent these infections, vaccination rates remain below 75 percent of the at-risk adult population(2). People at-risk for pneumococcal disease include the elderly and patients with suppressed immunity against encapsulated organisms such as diabetic and asplenic patients as well as those with chronic cardiovascular and pulmonary diseases. The public health initiative Healthy People 2010 calls for an increase in the number of eligible patients receiving pneumococcal vaccine over the next decade, with particular focus on currently underserved patient populations(3). In order to attain this goal, the Centers for Disease Control and Prevention (CDC) have advocated nontraditional programs conducted by nonphysician health care professionals(4). Their program highlights pharmacists among others as a group of professionals poised to implement and conduct vaccination programs.

Pharmacy students are also becoming involved in vaccine initiatives. For example, the student group associated with the American Pharmaceutical Association, Academy of Students of Pharmacy (APhA-ASP), conducts an annual program providing influenza vaccine throughout the community. In order to provide these services in the future, pharmacy schools nationwide are including vaccination training as part of required or elective curricula.

Pharmacist managed vaccination programs have traditionally targeted the outpatient population. Although, more recently, a group of hospital pharmacists demonstrated the ability to increase vaccination rates by screening patients admitted to the hospital for vaccine eligibility(5). We report the results of a similar initiative conducted by Doctor of Pharmacy students completing adult internal medicine rotations.

METHODS

The program was conducted by fourth-year Doctor of Pharmacy candidates completing required adult internal medicine experiential rotations from three different schools of pharmacy (Campbell University School of Pharmacy, The University of North Carolina School of Pharmacy, and Idaho State University School of Pharmacy). Faculty preceptors for the program were from the two schools of pharmacy located in North Carolina with practice sites at four different institutions throughout the state (Duke University Medical Center, Durham Veterans' Affairs Hospital, Durham Regional Hospital (Durham, NC) and Pitt County Memorial Hospital (Greenville, NC)).

Program components were outlined during routine student orientation to the internal medicine rotation. This consisted of a review of the benefits of pneumococcal vaccination, Advisory Committee on Immunization Practices (ACIP) guidelines outlining candidates for vaccination, and vaccine contraindications. Students were provided with copies of the ACIP Guidelines for Pneumococcal Vaccination(l), the package insert for the vaccine used at the institution, primary literature outlining a similar in-patient vaccination program(5), and copies of the data collection form (Appendix). Students were also provided with contact information for their preceptor and the principal investigator of the study. Subsequent faculty participation included collection of completed forms and assisting students with questions as needed.

Students were responsible for screening all patients admitted to their service for vaccine eligibility. This process included a review of the patient's medical record, patient interview, and when necessary contacting the patient's primary medical provider to determine prior vaccine history. Vaccine-eligible patients were those who met criteria to receive vaccination as described by the ACID guidelines as follows: anyone greater than 65 years old, or less than 65 years old with at least one risk factor. These included diabetes mellitus, alcoholism, functional or anatomic asplenia, chronic liver disease, chronic pulmonary or cardiac disease, human immunodeficiency virus (HIV) and living in a special environment or social setting such as a nursing home. Vaccination candidates were patients meeting ACIP eligibility criteria who had not been previously vaccinated. Once a vaccination candidate was identified, the student would then present their recommendation directly to the medical team. If accepted, the order was written either by the physician caring for the patient, or by the pharmacy faculty member as a verbal order from the appropriate member of the medical team. Students were also responsible for follow-up to ensure whether the vaccine was administered and to record vaccine-related adverse events.