Nurse-Driven Pneumonia Vaccination Initiative in Adult Primary Care

Pneumococcal disease is a leading cause of vaccine-preventable illness and death”.1 Pneumococcal vaccines are recommended for patients age 65 and over and high-risk patients, however adherence rates remain low.1 Two pneumococcal vaccines are available for older adults: Pneumococcal conjugate vaccine for adults 65 and older (PCV13/prevnar 13) and pneumococcal polysaccharide vaccine (PPSV23/pneumovax 23).

The nurses at adult primary care, a primary care clinic serving the underinsured, uninsured, and most vulnerable population of Hartford, CT, and surrounding areas, in line with the CDC Healthy People 2020 National Immunization Goals 2 saw the need to increase vaccinations in the ambulatory care setting for patients who were identified with a COPD diagnosis. Approximately 200 patients were identified and placed into four categories: patients with no history of pneumococcal vaccinations, patients who have received/not received PPSV23, patients who have not received PCV13, and patients who have received both PPSV23 and PCV13.

This nurse-driven initiative involved members of the whole team, including medical assistants who called eligible patients that were identified to come to the office for vaccinations during established pneumonia vaccination clinics. Nurses also proactively reviewed provider schedules for patients aged 65 and older who needed PCV13 vaccination. A best practice advisory (BPA) was established in the electronic medical records (EMR) with the support from the Hartford HealthCare (HHC) system support office to alert providers of the patients’ need for the pneumococcal vaccine. Vaccination rates for the population in this pilot increased as a result of this initiative: pneumovax 23 vaccination increased to 89% and prevnar 13 vaccination increased to 77%. In conclusion, the BPA has increased providers awareness to patients’ need for vaccinations in general. Once the BPA proved effective, HHC began using the BPA system wide to increase vaccinations rates. We have also seen an increase in vaccinations rates for TDap, hepatitis A, hepatitis B and influenza.

References
1. Pennant, K, Costa,J, Fuhlbrigge,A, Sax, P, Szent-Gyorgyi, L, Coblyn, J Desai,S. Improving Influenza and Pneumococcal Vaccination Rates in Ambulatory Specialty Practices. Open Forum Infectious Diseases 2015;1-9.
2. CDC. Healthy People 2020 National Immunization Goals.