Point of care experience with pneumococcal and influenza vaccine documentation among persons aged >= 65 years: High refusal rates and missing information
Division of General Internal Medicine and Geriatrics, College of Medicine, Medical University of South Carolina, Charleston, SC 29425-0591, USA.American journal of infection control (Impact Factor: 2.21). 03/2012; 40(7):672-4. DOI: 10.1016/j.ajic.2011.12.006
Missed opportunities to vaccinate and refusal of vaccine by patients have hindered the achievement of national health care goals. The meaningful use of electronic medical records should improve vaccination rates, but few studies have examined the content of these records. In our vaccine intervention program using an electronic record with physician prompts, paper prompts, and nursing standing orders, we were unable to achieve national vaccine goals, due in large part to missing information and patient refusal.
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ABSTRACT: Objectives: The 23-valent pneumococcal vaccine has been shown to be effective in reducing mortality and complications from pneumonia. The US Centers for Disease Control (CDC) have published guidelines for vaccination eligibility. The intensive care unit (ICU) may represent a missed opportunity for administration of the pneumococcal vaccine to eligible patients. This study assessed the characteristics of patients in an ICU in relation to their candidacy for pneumococcal vaccination. RESEARCH METHODOLOGY/SETTING: A retrospective chart review was performed of all patients with a single admission to a mixed 25 bed ICU of a tertiary-care community teaching hospital from October 2010 to January 2011. Information procured included demographic information, pneumococcal vaccine eligibility, documentation of prior vaccination status or vaccine administration and patient outcomes. Results: Two-hundred and sixty three individual medical and surgical admissions to the ICU occurred during the study period. The mean number of indicator risk factors for pneumococcal vaccine was 2.3 (95% CI (2.117-2.513), with the majority of patients being over age 65 (57%) and having chronic heart or lung disease (81%). Despite this only seven patients had immunisation status documented and only 14 patients received pneumococcal vaccination during the index hospital stay. Conclusion: In a large tertiary-care teaching hospital, most patients admitted to the ICU had multiple indications for pneumococcal vaccination. However, only a small percentage were assessed or given vaccination during their hospital stay. ICU protocols that give nurses the ability to assess and administer pneumococcal vaccines may improve immunisation rates.
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ABSTRACT: To better understand why immunosuppressed individuals with systemic lupus erythematosus (SLE) fail to receive influenza and pneumococcal vaccines. These cross-sectional data were derived from the 2009 cycle of the Lupus Outcomes Study (LOS), an annual longitudinal telephone survey of individuals with confirmed SLE. Respondents were included in the analysis if they had taken immunosuppressive medications in the past year. We assessed any prior receipt of pneumococcal vaccine and influenza vaccine in the past year, and then elicited reasons for not receiving vaccination. We used bivariate statistics and multivariate logistic regression to assess frequency and predictors of reported reasons for not obtaining influenza or pneumococcal vaccines. Among 508 respondents who received immunosuppressants, 485 reported whether they had received vaccines. Among the 175 respondents who did not receive an influenza vaccine, the most common reason was lack of doctor recommendation (55%), followed by efficacy or safety concerns (21%), and lack of time (19%). Reasons for not receiving pneumococcal vaccine (N = 159) were similar: lack of recommendation (87%), lack of time (7%), and efficacy or safety concerns (4%). Younger, less-educated, non-white patients with shorter disease duration, as well as those immunosuppressed with steroids alone, were at the greatest risk for not receiving indicated vaccine recommendations. The most common reason why individuals with SLE did not receive pneumococcal and influenza vaccines was that physicians failed to recommend them. Data suggest that increasing vaccination rates in SLE will require improved process quality at the provider level, as well as addressing patient concerns and barriers. Copyright © 2015 Elsevier Inc. All rights reserved.
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ABSTRACT: Objective Racial disparities in rates of pneumococcal vaccine (PPSV23) exist. In one practice, 3.1 % of white patients refused PPSV23 following doctor recommendation, whereas 11.2 % of black patients refused vaccination. Our objective was to understand reasons black patients refused PPSV23. Methods Mixed-method telephone survey in 2012 of black patients aged ≥65 with a documented refusal of PPSV23. The survey assessed beliefs about PPSV23; reasons for non-receipt of PPSV23; receipt of other vaccinations; and comparative perceptions of adult vs. childhood vaccines. Participants responded to items on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results Participants’ (N = 40) mean age was 73 years; 95 % were female. Participants recognized pneumonia could be deadly (M = 4.3, SD = 1.0), but reported low levels of personal susceptibility (M = 2.8, SD = 1.4). Participants perceived childhood vaccines to be safer (M = 4.2, SD = 1.2) than adult vaccines (M = 3.4, SD = 1.4; p < 0.01). Qualitative analyses to understand reasons for refusal of vaccine both reinforced identified low perceptions of personal susceptibility as well as identified numerous additional barriers to receipt of PPSV23 (e.g., fear, side effects, and mistrust). Conclusions Black patients in our sample who refused PPSV23 may not perceive themselves susceptible to the disease, suggesting that strategies to improve PPSV23 rates among these patients may need to emphasize susceptibility to pneumonia. Further, given the discrepancies in perceptions toward childhood versus adult vaccinations, focusing on vaccination across the lifespan may be a promising vaccine promotion strategy.