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618
voluntary to the Centers of Medicare and Medicaid Services
in 2014.1 These disease states contribute substantially to the
national disease burden with influenza resulting in an average of more than 200,000 excess hospitalizations annually
and 37% of all hospitalizations for individuals greater than
65 years of age.5 Pneumococcal pneumonia results in an estimated 400,000 hospitalizations per year with a case fatality
rate of 5% to 7%.6 In adults 65 years of age or older, influenza and pneumonia combined are the fifth leading cause
of death in the United States.7 Despite the benefits of immunization in disease prevention, data suggest that inpatient
immunization rates for hospitalized patients are low.8 Further
highlighting the missed opportunities associated with immunizing hospitalized patients is the finding that two-thirds of
vaccine-eligible inpatients had a prior hospitalization within
the previous five years but were unvaccinated.8-9 In an effort
to combat the high disease burden of these preventable
diseases and align with quality metrics, health-system have
been challenged to optimally align their resources in an effort
to improve inpatient vaccination rates.
With the increased focus on quality and outcomes, pharmacy departments have been involved in several initiatives
targeted at improving vaccination rates. However, the optimal role of health-system pharmacists and pharmacy departments in improving inpatient vaccination rates has not been
well described. The American Society of Health-System
Pharmacists guidelines on the pharmacist's role in immunization recommend pharmacists be involved in history and
screening, patient counseling, documentation, formulary
management, administrative measures, and public education
regarding immunizations.10-12 An effective strategy which
has been recommended and employed by many healthsystems includes a standing orders program (SOP), which
enables nurses and pharmacists as allowed by state law, to
screen patients for eligibility and administer vaccinations in
the absence of a physician order.13-21 Pharmacists have previously demonstrated their value in improving vaccination
rates through targeted follow-up reminders to physicians and
pharmacist-managed SOP's.8,22-26 An additional method utilized by pharmacy departments has been development of a
collaborative drug therapy management (CDTM) agreement
which authorized pharmacists to write influenza and pneumococcal orders for eligible patients which similarly resulted
in improved vaccination rates.27 These pharmacy-driven initiatives have led to improved inpatient vaccination rates but
have been resource-intensive consisting of manual chart
review, patient interviews, and follow-up. These initiatives
were also predominantly focused on pharmacist activities
and involvement. However, data supporting pharmacy technician involvement in pharmacy-department wide initiatives
to improve vaccination rates in the inpatient setting are limited. The purpose of this study was to evaluate a pilot utilizing pharmacy technician interventions, in combination with
a nursing SOP, to improve vaccination rates during the weekend days.

Hospital Pharmacy 52(9)

Background
The University of Kansas Health-System (UKH) is a 759-bed
tertiary, academic medical center located in Kansas City,
Kansas. The UKH practice model is an integrated, teambased, patient-centered, care model, with pharmacist services provided along clinical service line. A recent practice
model change has facilitated increased involvement of pharmacy personnel in both the admission and discharge medication reconciliation process leading to a decrease in
readmissions.28 Pharmacy technicians play a pivotal role in
completing these admission medication reconciliations,
through the emergency department, general nursing floors,
and preoperatively. In addition, pharmacy technicians are
involved in several nontraditional roles including management of other pharmacy technicians, nonsterile compounding operations, technician-check-technician for manual
automated dispensing cabinet (ADC) refills, and oversight of
pharmacy purchasing. The UKH utilizes a hybrid dispensing
model with ADCs located on nursing units. Pharmacy technicians serve in decentralized roles to refill medications in
the ADCs, hand-deliver medications to the floor, and interact
with nursing to facilitate medication reconciliation.
The achievement of the goal of immunizing 100% of
patients for either the influenza or pneumococcal vaccines
has been challenging to accomplish at UKH. Nurses have
been charged with the task to screen, order, and administer
pneumococcal and influenza vaccines for all patients admitted utilizing an SOP. In completing the vaccination process,
nurses currently fill out the admission documentation utilizing the "Admission Navigator" function within the electronic
medical record (EMR), Epic (Epic System Corporation,
Verona, Wisconsin). The navigator guides nursing through a
standard list of questions to identify patients indicated for
either the influenza or pneumococcal vaccine or to document
patient refusal or contraindication. Once patients have been
screened with this tool, the documentation process is completed through an order set. While this process is frequently
accomplished, some patients may be discharged without
appropriate screening or immunization. Nurse managers and
the infectious disease pharmacist receive reports Monday
through Friday on all admitted patients who do not have a
completed vaccination order set to facilitate appropriate follow-up. However, this same activity is not performed on
weekends, primarily due to changes in staffing levels.

Methods
A process was designed and implemented to identify, screen,
and administer immunizations to patients indicated for the
influenza and pneumococcal vaccines during weekend days
on the 32-bed Cardiovascular Progressive Care (CVP) unit at
the UKH. A pre/post analysis was conducted to assess immunization rates over four consecutive weekends in October
2011. During the first two weekends of the study period, the



Table of Contents for the Digital Edition of Hospital Pharmacy - October 2017

Pharmacists and Medical Missions
Current FDA-Related Drug Information
Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
Pharmaceutical Pipeline Update
Cholesterol Ester Transfer Protein Inhibitor Review
Formulary Drug Review
Ocrelizumab
Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review
Development of a Pharmacy Technician–Driven Program to Improve Vaccination Rates at an Academic Medical Center
Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients
Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center
Impact of Inpatient Automatic Therapeutic Substitutions on Postdischarge Medication Prescribing
Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses
Administration of Injectable Vitamin K Orally
Hospital Pharmacy - October 2017 - 577
Hospital Pharmacy - October 2017 - 578
Hospital Pharmacy - October 2017 - 579
Hospital Pharmacy - October 2017 - 580
Hospital Pharmacy - October 2017 - 581
Hospital Pharmacy - October 2017 - 582
Hospital Pharmacy - October 2017 - 583
Hospital Pharmacy - October 2017 - 584
Hospital Pharmacy - October 2017 - 585
Hospital Pharmacy - October 2017 - 586
Hospital Pharmacy - October 2017 - 587
Hospital Pharmacy - October 2017 - 588
Hospital Pharmacy - October 2017 - Pharmacists and Medical Missions
Hospital Pharmacy - October 2017 - Current FDA-Related Drug Information
Hospital Pharmacy - October 2017 - Summaries of Safety Labeling Changes Approved By FDA- Boxed Warnings Highlights April-June 2017
Hospital Pharmacy - October 2017 - 592
Hospital Pharmacy - October 2017 - Pharmaceutical Pipeline Update
Hospital Pharmacy - October 2017 - Cholesterol Ester Transfer Protein Inhibitor Review
Hospital Pharmacy - October 2017 - 595
Hospital Pharmacy - October 2017 - Formulary Drug Review
Hospital Pharmacy - October 2017 - Ocrelizumab
Hospital Pharmacy - October 2017 - 598
Hospital Pharmacy - October 2017 - 599
Hospital Pharmacy - October 2017 - 600
Hospital Pharmacy - October 2017 - 601
Hospital Pharmacy - October 2017 - 602
Hospital Pharmacy - October 2017 - 603
Hospital Pharmacy - October 2017 - 604
Hospital Pharmacy - October 2017 - Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review
Hospital Pharmacy - October 2017 - 606
Hospital Pharmacy - October 2017 - 607
Hospital Pharmacy - October 2017 - 608
Hospital Pharmacy - October 2017 - 609
Hospital Pharmacy - October 2017 - 610
Hospital Pharmacy - October 2017 - 611
Hospital Pharmacy - October 2017 - 612
Hospital Pharmacy - October 2017 - 613
Hospital Pharmacy - October 2017 - 614
Hospital Pharmacy - October 2017 - Development of a Pharmacy Technician–Driven Program to Improve Vaccination Rates at an Academic Medical Center
Hospital Pharmacy - October 2017 - 616
Hospital Pharmacy - October 2017 - 617
Hospital Pharmacy - October 2017 - 618
Hospital Pharmacy - October 2017 - 619
Hospital Pharmacy - October 2017 - 620
Hospital Pharmacy - October 2017 - Safety and Efficacy of Enoxaparin Compared With Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Hemodialysis Patients
Hospital Pharmacy - October 2017 - 622
Hospital Pharmacy - October 2017 - 623
Hospital Pharmacy - October 2017 - 624
Hospital Pharmacy - October 2017 - 625
Hospital Pharmacy - October 2017 - Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center
Hospital Pharmacy - October 2017 - 627
Hospital Pharmacy - October 2017 - 628
Hospital Pharmacy - October 2017 - 629
Hospital Pharmacy - October 2017 - 630
Hospital Pharmacy - October 2017 - 631
Hospital Pharmacy - October 2017 - 632
Hospital Pharmacy - October 2017 - Impact of Inpatient Automatic Therapeutic Substitutions on Postdischarge Medication Prescribing
Hospital Pharmacy - October 2017 - 634
Hospital Pharmacy - October 2017 - 635
Hospital Pharmacy - October 2017 - 636
Hospital Pharmacy - October 2017 - 637
Hospital Pharmacy - October 2017 - Impact of Respiratory Viral Panel Polymerase Chain Reaction Assay Turnaround Time on Length of Stay and Antibiotic Use in Patients With Respiratory Viral Illnesses
Hospital Pharmacy - October 2017 - 639
Hospital Pharmacy - October 2017 - 640
Hospital Pharmacy - October 2017 - 641
Hospital Pharmacy - October 2017 - 642
Hospital Pharmacy - October 2017 - Administration of Injectable Vitamin K Orally
Hospital Pharmacy - October 2017 - 644
Hospital Pharmacy - October 2017 - 645
Hospital Pharmacy - October 2017 - 646
Hospital Pharmacy - October 2017 - 647
Hospital Pharmacy - October 2017 - 648
Hospital Pharmacy - October 2017 - 649
Hospital Pharmacy - October 2017 - 650
Hospital Pharmacy - October 2017 - 651
Hospital Pharmacy - October 2017 - 652
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