Using a vaccine manager to enhance in-hospital vaccine administration

Abstract

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

Methods: 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.

Results: 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.

Conclusions: 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.