Mandatory pneumococcal immunization became a required quality core measure for all hospitalized patients in 2012. In attempt to meet 100% compliance with this Joint Commission on Accreditation of Healthcare Organizations / Centers for Medicare and Medicaid Services (JCAHO/CMS) mandate, many patients may receive vaccination even though they do not meet any of the ACIP recommended indications, while others may be immunized a greater number of times than warranted.
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 (PPPSV23) as per the hospital's standing order immunization protocol.
During the time period studied, 28% of those patients who were vaccinated with PPSV23 (138/500) were done so not in accordance with ACIP recommendations. The majority (114/500) of the almost one-third of non-indicated immunizations were given to patients <65 years old, while the remainder occurred in persons aged >65 years who had already been vaccinated once after this birthdate. 14% of those vaccinated were unaware of their previous vaccination status.
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.
L. Bush, None