No Spleen, No Problem: Using Community Pharmacists to Increase Vaccination Rates after Splenectomy

Approximately 1 in 20 patients who have splenectomies develop infections later in life. Although these infections are rare, they are life-threatening and 50-70% of infected patients die. Part of the problem is that asplenic patients are at elevated risk of infection with Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenza type B. These encapsulated organisms are notoriously difficult to treat.

The journal Research and Social and Administrative Pharmacy has published a study about the pharmacist's role in vaccinating asplenic patients. Conducted by a team of pharmacy researchers located in Columbus, Ohio, the study identifies a clear role for community-based vaccination for these patients.

In this study, the researchers conducted retrospective cohort analysis using a tracking system built into the electronic medical record. It identified patients who were asplenic and gaps in their immunization status.

This study included 261 participants, more than half of whom had splenectomies due to malignancies.

Prior to the intervention, 68% of patients had been vaccinated. After the intervention, that number increased to 77%. Overall, gains were not statistically significant, but notable. Greatest gains (results that reached statistical significance) were noted in compliance with guideline-recommended pneumococcal vaccination series.

Pharmacy-driven electronic tracking helped increase vaccination rates; experts indicate that increased vaccination uptake in asplenic patients helps, regardless of the magnitude of the change.

An additional finding was that poor documentation was a serious concern in asplenic patients' electronic medical records. It made it very difficult to determine if the patient had been vaccinated or when.

The authors noted that one of the study's most serious limitations was that oncology pharmacists were less likely to use the tracking system than others. Since so many patients are asplenic as a consequence of cancer, engaging oncology pharmacists in tracking would be expected to make a more significant change. The researchers noted that pharmacists need to be integral parts of the vaccination workflow to be most effective.

Pharmacists may have difficulty keeping up with vaccination guideline changes. Different types of vaccines for the same indication can add to the confusion. Incorporating guideline changes and appropriate vaccines into the electronic medical record tracking system may help reduce that confusion, according to the researchers.

Reference

Rihtarchik L, Murphy CV, Porter K, Mostafavifar L. Utilizing pharmacy intervention in asplenic patients to improve vaccination rates. Res Social Adm Pharm. 2017 Apr 24. pii: S1551-7411(16)30560-5. doi: 10.1016/j.sapharm.2017.04.013. [Epub ahead of print]