Category: Federal Forum Posters
Purpose: Patients who have undergone cardiothoracic transplant surgery require lifelong immunosuppression to prevent rejection of the transplanted organ. This leaves transplant recipients susceptible to multiple infectious diseases, many of which are vaccine preventable. The purpose of this project is to determine the impact pharmacists have on cardiothoracic transplant recipients vaccination status at the time of transplant surgery.
Methods: A retrospective cohort analysis at a single Veterans Administration hospital was completed to assess vaccination status at the time of transplant. In 2012, a pharmacist was added to the transplant team and started to meet with each Veteran to discuss transplant medications and recommended vaccinations prior to transplant. Prior to 2012, a pharmacist did not evaluate Veterans prior to transplant. All Veterans who received a heart or lung transplant at our institution between January 2008 and January 2011 before pharmacist intervention were compared to patients transplanted between January 2014 and January 2017 after pharmacist intervention. The primary outcome of the project was the change in vaccination rate at the time of transplant upon pharmacist involvement. Secondary outcomes included: the number of recipients fully vaccinated at the time of transplant, the percent change in vaccinations administered for each individual vaccination, and the difference in readmissions for preventable infectious diseases 12 months post-transplant. The 2013 Infectious Disease Society of America guidelines for vaccination of immunocompromised patients were followed. This project was determined to be a Quality Improvement project, therefore, was Institutional Review Board exempt. Comparisons were analyzed using Chi-squared or Fisher’s exact test.
Results: There was a 126 percent increase in vaccinations administered per person after the intervention. The intervention group had 6.04 vaccines administered per patient compared to the control group with 2.67 vaccines administered per patient. Thirty percent of patients were fully vaccinated at time of transplant in the intervention group compared to zero percent in the control group (p-value: <0.001). The percent of patients re-admitted within 12 months for a vaccine preventable disease did not differ significantly between the control and intervention group (13% vs. 10%) respectively (p-value: >0.05). Vaccine administration statistically significantly increased by 64 percent for PCV13, 59 percent for zoster, 83 percent for Tdap, 17 percent for influenza, 60 percent for hepatitis A and 44 percent for hepatitis B. Vaccine administration reduced by 6 percent for PPSV23, though the difference was not statistically significant.
Conclusion: Pharmacist-involvement at the time of transplant improved vaccination rates and increased the number of patients fully vaccinated at time of transplant.
Kathryn Zaborowski– PGY2 Ambulatory Care Pharmacy Resident, William S. Middleton Memorial Veterans Hospital, Middleton, WI