Using a vaccine manager to enhance in-hospital vaccine administration

Immunizations are effective and safe but underutilized. Inpatient hospitalizations offer an opportunity to update immunizations for both children and adults.

We tested two strategies for administering vaccines to hospitalized adults: a nurse practitioner vaccine manager, who assessed patient needs and administered vaccines without the attending physician's signature; and enhanced usual care, ie, need assessed by floor nurses and vaccines ordered by attending physicians. Evaluation was based on immunization rates during 2 preintervention months compared with immunization rates during the 3-month intervention period, and on interviews with nurses and physicians regarding their evaluation of the acceptability of the two strategies.

Three percent of patients needing a vaccine received it during hospitalization in the 2-month baseline period before our intervention. During the intervention period, 1252 patients were admitted and available for assessment; 821 were assigned to the "enhanced usual-care" floors and 431 to the "vaccine-manager" floors. Of the patients receiving enhanced usual care, 54% had either inadequate or no assessment of vaccine need. Seventy-three percent of those who were properly assessed needed at least one vaccine, yet only 4% of those patients received a vaccine. All patients on the vaccine-manager floors were assessed; of these, 47% needed one or more vaccines. Thirty-four percent of patients needing a vaccine received it; however, 47% of patients needing a vaccine refused it. The family nurse practitioner spent an average of 15 minutes per patient in providing this service. Qualitative interviews with staff nurses and physicians demonstrated support for a separate vaccine manager program to immunize patients.

A specially dedicated vaccine manager can be more effective in assessing the need for and in delivering vaccines than can attending physicians working with floor nurses. Using a vaccine manager, these tasks also can be accomplished in a reasonable time. Hospital staff regard this approach as acceptable.