766. Protecting Newborns from Pertussis through Improving the Rate of Post-Partum Tetanus, Diptheria, and Acellular Pertussis (Tdap) Vaccination via a Pharmacist Driven Protocol
Session: Oral Abstract Session: Pertussis Vaccines and Challenges
Friday, October 21, 2011: 3:30 PM
Room: 156ABC
Background: In the last decade, US Pertussis cases have increased dramatically.  In 2009, The Centers for Disease Control reported nearly 17,000 cases of pertussis including 12 infant deaths.  The Advisory Committee on Immunization Practices updated recommendations for Tdap vaccination in 2005 to encompass all individuals ages 11-64 years who anticipate having close contact with an infant aged less than 12 months.  Despite recommendations, Tdap vaccination rates are estimated at 56% among adolescents and <6% among adults.   The goal of this project was to increase the rate of post-partum Tdap vaccination thereby protecting infants from pertussis.

Methods: A protocol approved by the hospital’s Pharmacy & Therapeutics Committee enabled pharmacists to order Tdap for all women admitted to the obstetrics service.  Patients were assessed via an electronic admission assessment by nursing to determine if the patient received Tdap in the past 2 years or reported a prior history of a severe reaction to any vaccine component.  A pharmacist reviewed the assessment and, if indicated, entered an order for the patient to receive Tdap post-partum, prior to discharge.  Nurses and pharmacists were educated about the new vaccination protocol.  Education was provided to the parents regarding risks associated with pertussis.

Results: Retrospective data collected from June–November 30, 2010 (n=2145) revealed 10% of post-partum women received Tdap prior to discharge before implementation of the pharmacist-driven protocol.  After implementation of the protocol, data from February–May 1, 2011 (n=1009) revealed 99% of women admitted to the obstetrics service had a completed nursing assessment, 96% of women qualified to receive the vaccine, and of the qualifying mothers, 99.5% had a Tdap order entered and 80.5% received the vaccine prior to discharge.  This reflects a 70.5% increase in receipt of the vaccine (p<0.0001).  The only demographic data associated with vaccination refusal was white race (p=0.003). 

Conclusion: With implementation of a pharmacist-driven vaccination protocol, the number of women assessed, the amount of orders entered, and the receipt of Tdap vaccination in post-partum women markedly increased, thereby reducing the risk of neonatal pertussis in our population.

Subject Category: I. Adult and Pediatric Vaccines

Lindsey Klish, Pharm.D.1, Michael Ruggero, Pharm.D.1, Heather Lipkind, MD1,2, Liz O'Mara, RN, BSN1, Sarah Arnold, Pharm.D.1 and Jeffrey Topal, MD1,2, (1)Yale-New Haven Hospital, New Haven, CT, (2)Yale School of Medicine, New Haven, CT


L. Klish, None

M. Ruggero, None

H. Lipkind, None

L. O'Mara, None

S. Arnold, None

J. Topal, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.