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Published on: February 9, 2011
Missed opportunities to vaccinate children admitted to a paediatric tertiary hospital
Suzanne Walton1, David Elliman, Helen Bedford
1UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK.
Insights
Paediatric inpatients have lower immunisation rates, and UK hospitals miss opportunities to vaccinate them. This study highlights gaps in identifying and facilitating vaccinations for children in tertiary care settings.
Area of Science:
- Pediatric healthcare
- Public health
- Immunization practices
Background:
- Significant inequalities in vaccine uptake persist.
- Paediatric inpatients demonstrate lower immunisation rates compared to the general population.
- UK policies promote opportunistic immunisation strategies.
Purpose of the Study:
- To assess the identification and vaccination facilitation practices for under-immunised inpatients within a tertiary paediatric hospital.
- Evaluate current hospital procedures for managing childhood immunisations.
Main Methods:
- Review of 225 inpatient case notes.
- Interviews with 30 healthcare professionals across various roles.
- Analysis of hospital policies, forms, and relevant documents.
Main Results:
- Immunisation status documented for 71% of admissions; 69% marked 'up-to-date' without detail.
- At least 20% of inpatients were found to be incompletely immunised.
- Limited efforts to facilitate vaccination, lack of staff training, inconsistent policies, and outdated schedules were identified.
Conclusions:
- Healthcare services at all levels are missing opportunities for childhood immunisation.
- Tertiary centres should support primary care in ensuring vulnerable children are fully vaccinated.
- Addressing identified issues is crucial, with implications for other UK hospitals.
Background:
Inequalities in vaccine uptake exist. Studies suggest paediatric inpatients have lower rates of immunisation uptake than the general population. Various UK policies advocate opportunistic immunisation.
Aim:
To evaluate practice within a paediatric tertiary hospital in identifying and facilitating vaccination of inpatients who were not fully immunised.
Methods:
Case notes for 225 inpatients were examined. Thirty staff of various professions and grades were interviewed. Policies, forms and documents used in the hospital were reviewed.
Results:
Immunisation status was recorded for 71% of children admitted, but for 69% of these immunisations were documented as "up-to-date" without any further information recorded. At least 20% of inpatients were incompletely immunised, but very little was done to facilitate vaccination. There was no training for staff either in giving advice or in administering vaccines and staff views differed regarding the hospital's role in immunisations. While there were guidelines for specific groups of patients, there were no general immunisation policies. Incorrect and out-of-date immunisation schedules were found on documents.
Conclusions:
Opportunities to immunise children continue to be missed by all levels of health care service provision. Tertiary centres have a role to play in supporting primary care services to ensure that these vulnerable children are appropriately immunised. Measures are being taken to address the problems identified in this study and we strongly suspect that other hospitals in the UK ought to be confronting these issues as well.
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