Unwarranted Pneumococcal Vaccination in an Acute Care Hospital Related to Core Quality Measure Initiatives

Abstract

Background 

Mandatory pneumococcal immunization became a required quality core measure for all hospitalized patients in 2012. In the attempt to meet 100% compliance with this Joint Commission on Accreditation of Health Care Organizations/Centers for Medicare and Medicaid Services mandate, many patients may receive vaccination even though they do not meet any of the Advisory Committee on Immunization Practice recommended indications, whereas others may be immunized a greater number of times than warranted.

Methods 

This is a retrospective review of the hospital record of 500 consecutive patients admitted to a large urban medical center between April 2014 and July 2014 who received the pneumococcal polysaccharide vaccine (PPSV23) as per the hospital's standing order immunization protocol.

Results 

During the period studied, 28% of those patients who were vaccinated with PPSV23 (138/500) were done so not in accordance with Advisory Committee on Immunization Practice recommendations. The majority of the almost one third of nonindicated immunizations were given to patients younger than 65 years, while the remainder occurred in persons aged older than 65 years who had already been vaccinated once after this birthdate.

Conclusions 

In the interest of improving and standardizing the quality of care, hospital policies created to satisfy mandated core measures may promulgate unintentional consequences, some of which could potentially be harmful. This study demonstrated that an effort to achieve 100% compliance with the pneumococcal immunization “all-or-none” expectation led to evidence-based immunization guideline recommendations not being correctly adhered to.