Staff versus physician vaccine protocols for influenza immunization during pregnancy

Pregnant women and their fetuses are known to be at increased risk for influenza-associated morbidity and mortality. The Advisory Committee on Immunization Practices and others have recommended influenza vaccination for all pregnant women at any gestational age, but vaccination rates for pregnant women remain low, near 45%.

A retrospective chart review was performed at each of 4 sites during the 2010 to 2011 and 2011 to 2012 influenza seasons to examine the rates of flu vaccination offering and provision. The 4 separate clinics used for this study included 3 sites within a large university academic center and one private community practice. A nurse-driven (licensed vocational nurse or medical assistant staff) protocol for offering the flu vaccine was used at one site the first year of review and then used at 2 sites during the second year of review. We compared the vaccination offering and provision rates when nurse-driven or physician-driven protocols were used.

With the nurse-driven protocol, the average offering rate was 99.7%, but of those who were offered the vaccine, only 38.2% received it, for a total effective vaccination rate of 38.1% of the patients. With the physician-driven protocol, 54.5% patients were offered the vaccine, and 70.7% of those received it, for an effective total vaccination rate of 38.5%.

In this retrospective observational report, a nurse-driven protocol did not improve vaccination rates across varying practice sites. Thus, a simple protocol change to staff alone offering vaccine is unlikely to improve rates of maternal influenza vaccination. Additional studies looking at interventions to increase the number of pregnant women vaccinated against influenza are needed.