Immunizing in the Inpatient Setting

August is National Immunization Awareness month, which means back-to-school physicals and likely a new round of pseudoscience stirred up by the antivaccine crowd. Perhaps some have forgotten the consequences of failing to vaccinate our children.

Credit: National Institutes of Health

Pediatricians and family practitioners haven’t, and based on new data presented at the Pediatric Hospital Medicine 2011 meeting in Kansas City, nor have their hospitalist colleagues.The Children’s Hospital of Wisconsin in Milwaukee has developed a process to identify and immunize hospitalized children prior to discharge. Milwaukee County lags significantly behind national and Wisconsin child-immunization rates, with just 47% of 2-year-old inpatients fully immunized, compared with about 83% in all of Wisconsin and 81% nationally, Dr. Anjali Sharma explained at the meeting.

“We did the study because we felt an obligation,” she said.  “With so many patients that are obviously not able to get it done at their primary physicians for whatever reason, we really wanted to get them immunized and see if there are other avenues to eliminate these missed opportunities.”

The four-pronged process includes printing an immunization record from the Wisconsin Immunization Registry (WIR) at admission, having nurses screen for vaccine contraindications using the CDC tool, educating physicians about the importance of ordering immunizations and true immunization contradictions, and developing a standardized order set to immunize children at discharge.

During the prospective, pilot project test period, 414 children were admitted to the hospital, with 142 eligible for vaccines.

Only 13, or 9%, of these children were fully immunized, leaving 129 patients with missed vaccine opportunities, Dr. Sharma said.

Moreover, 60% of the 129 patients remained not fully immunized 6 months after discharge.

“It’s obvious we want to get more kids immunized in the hospital because those really, truly were missed opportunities because they didn’t get immunized later,” she said.

Contrary to popular belief, true contradictions to immunization occurred in just 5% of cases. Other reasons for the missed opportunities include WIR records not being reviewed, screening tools going uncompleted because of nursing disinterest and physician error.

Since the study, Children’s Hospital has begun a 5-year immunization initiative to address this issue.  Changes include linking hospital electronic health records to the WIR, process improvement, and education of staff at all levels, according to the authors of the study, led by pediatric hospitalist Dr. Angela Bier at the Medical College of Wisconsin, also in Milwaukee.

— By Patrice Wendling

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Filed under Allergy and Immunology, Drug And Device Safety, Family Medicine, Hospital and Critical Care Medicine, IMNG, Infectious Diseases, Internal Medicine, Pediatrics

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