Utilizing pharmacy intervention in asplenic patients to improve vaccination rates

Asplenic patients are at increased risk for post-splenectomy infection caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type B (Hib), and vaccination rates against these organisms remain low. The purpose of this study was to evaluate vaccination rates before and after implementation of a pharmacist-driven electronic vaccination tracking system.

This retrospective cohort analysis compared adult splenectomy patients before and after implementation of a pharmacist-driven tracking system with a primary outcome of complete initial vaccination. The system included use of an i-Vent to track and communicate vaccination status and a bundled vaccination order set. Complete initial vaccination was defined as documented administration of the following vaccines: pneumococcal, meningococcal, and Hib. Secondary outcomes included complete follow-up vaccination and factors associated with incomplete vaccination.

A total of 261 patients were included for analysis (142 pre-intervention, 119 post-intervention). The most common indication for splenectomy was malignancy (52.1% pre-intervention, 47.9% post-intervention). Complete initial vaccination rates increased by almost 10% post-intervention from 68.3% to 77.3% (p = 0.11). There was a statistically significant increase with guideline recommended pneumococcal (13-valent) as part of the initial vaccination series (p < 0.001).

Implementation of a pharmacist-driven electronic vaccination tracking system and bundled order set may increase rates of vaccination among asplenic patients. Although this improvement was not statistically significant, it is still clinically impactful. One limitation of the study was many outpatient oncology pharmacists were not utilizing the tracking tool at the time of data collection. Projected vaccination rates are likely higher now that more pharmacists are aware of this tool.