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Pneumococcal Vaccination in Rheumatology: Utilizing Nurse-Driven Protocol For Pneumococcal Vaccination in an Academic Rheumatology Clinic.

OBJECTIVE
Rheumatology patients are at high risk for complications from pneumococcal infections. The goal of this study was to assess the feasibility of implementing a nurse-driven pneumococcal vaccination protocol based on the 2012 Advisory Committee on Immunization Practices guidelines within an academic rheumatology clinic. Our aims were to increase 1) PCV13 and PPSV23 monthly vaccination rates in immunosuppressed patients aged 19-64 years and 2) the overall proportion of immunosuppressed patients aged 19-64 years who have received both PCV13 and PPSV23 vaccinations by ≥10% over a two-year period.


METHODS
We identified eligible adults in the Electronic Medical Record using a search protocol based on pre-set medication group. We obtained baseline pneumococcal vaccination rates in 2019, calculating the proportion of patients who were unvaccinated, partially vaccinated (received either PCV13 or PPSV23), or fully vaccinated. We created a pneumococcal vaccination protocol based on 2012 ACIP guidelines and converted it into a Standing Medical Order to be implemented by the nursing staff. Post-intervention vaccination rates were calculated monthly and at the end of the study period. Multiple comparison testing was performed to assess for significant post-intervention changes.


RESULTS
The average rate of monthly vaccination with either PCV13 or PPSV23 increased from 4.3% in 2019 to 12.6% in 2021. Proportion of patients who were fully vaccinated increased from 14.6% in 2019 to 26.2% in 2021. Both changes were statistically significant.


CONCLUSION
It is feasible to employ a nurse-driven protocol for improving pneumococcal vaccination rates in immunosuppressed patients, despite difficulties posed by COVID-19 pandemic disruptions.