Evaluation of a novel discharge reminder tool on pneumococcal vaccination in hospitalized elderly veterans

Study ObjectiveThe Advisory Committee on Immunization Practices (ACIP) recommendations for pneumococcal vaccinations include updates on appropriate spacing between the 13-valent conjugate vaccine (PCV13) and the 23-valent polysaccharide vaccine (PPSV23). The schedule may confuse providers leading to either vaccine omission or inappropriate vaccination. Numerous facilities have implemented inpatient reminder tools with limited success rates; however, the complexity of vaccine selection is not eliminated with this reminder approach nor does it provide education to the provider on ACIP recommendations. The Veterans Affairs Tennessee Valley Healthcare System implemented a tool to provide patient specific guidance and education on ACIP-appropriate vaccine selection embedded within a required discharge note called the discharge instruction inpatient note (DIPN). This study evaluates its impact on pneumococcal vaccination rates in hospitalized veterans 65 years of age and older. DesignThis was a single center, retrospective, observational analysis of pneumococcal vaccine utilization during the three-month periods surrounding DIPN implementation. PatientsA total of 540 patients aged 65 and older hospitalized in the Nashville campus of the Veterans Affairs Tennessee Valley Healthcare System. Measurements/Main ResultsPneumococcal vaccine utilization increased following DIPN implementation, with a total of 9 doses administered in the pre-DIPN group compared with 41 in the post-DIPN group (3.3% vs 15.2%, P < 0.0001). Among pneumococcal vaccine naive patients, vaccination at discharge increased from 1.4% to 25% following implementation (P = 0.0003). However, all 20 of the PPSV23 vaccines administered post-DIPN implementation were found to be inappropriate when compared with ACIP recommendations. ConclusionImplementation of a vaccine reminder tool embedded within the DIPN significantly increased the inpatient use of pneumococcal vaccines in a large VA facility with high baseline vaccination rates. Given the number of inappropriate vaccines administered, focused efforts on provider education in conjunction with implementation of reminder tools are warranted to encourage appropriate vaccine usage.