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Immunization - Adult/Pediatric - Inpatient [60]

Immunization - Adult/Pediatric - Inpatient [60] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 60

Delegation Protocol Title:
Immunization - Adult/ Pediatric - Inpatient

Delegation Protocol Applies To:
UW Health adult and pediatric (aged 6 months and older) patient admissions (Inpatient, Observation, and
Outpatient Short Stay).
Target Patient Population:
Adult and pediatric patients screened as eligible for inactivated influenza vaccine (IIV) and pneumococcal
vaccine (13-valent pneumococcal conjugate [PCV13] or 23-valent pneumococcal polysaccharide [PPSV23]) based
upon inclusion and exclusion criteria outlined in the protocol. Patient populations not addressed in this protocol
but that may benefit from receipt of pneumococcal vaccine should be referred to their primary care provider.
Delegation Protocol Champion:
James Conway, MD, FAAP - Department of Pediatrics, Infectious Disease
Delegation Protocol Reviewers:
Philip Trapskin, PharmD, BCPS - Manager, Inpatient Pharmacy Services and Drug Policy Program
Joshua Vanderloo, PharmD - Drug Policy Program
Sara Shull, PharmD, MBA, BCPS - Drug Policy Program

Responsible Department:
Department of Pharmacy

Purpose Statement:
Recognizing the morbidity and mortality associated with influenza and pneumococcal infections, UW Health is
committed to vaccinating against these infectious diseases. In addition, influenza and pneumococcal
vaccination compliance are part of national hospital quality process measures. This protocol delegates authority
from ordering providers to pharmacists to screen patients for IIV and pneumococcal vaccine (PCV13 and/or
PPSV23) eligibility, and order the vaccine when indicated. Furthermore, the protocol outlines vaccine
inclusion/exclusion criteria & screening, documentation, ordering, & administration expectations & workflow. In
the ambulatory environment, screening, ordering, and administering of vaccines is delegated to pharmacists
through Delegation Protocol: Immunization Ordering – Adult/Pediatric – Ambulatory [56]
Who May Carry Out This Delegation Protocol:
UW Health Pharmacists trained in the use of this delegation protocol.

Guidelines for Implementation:
I. The protocol is initiated with an order for admission to Inpatient, Observation, or Outpatient Short Stay
status
II. Vaccination History
A. The pharmacist will assess the vaccination history for:
1. Influenza (patients aged 6 months and older)
2. Pneumococcal vaccine (PCV13 and/or PPSV23) (patients aged 2 years and older)

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

B. Sources of history
1. Patient or caregiver interview
2. HealthLink
3. Wisconsin Immunization Registry
4. Healthcare providers external to UW Health
III. Pharmacist will review risks and benefits of vaccine based upon:
A. Centers for Disease Control and Prevention Vaccine Information Statement(s)
B. Inclusion / Exclusion criteria of the Immunization – Adult/Pediatric – Inpatient Delegation
Protocol
IV. Vaccine Specific Information
V. Inactivated influenza vaccine (IIV) dose exclusion criteria
A. Patient younger than 6 months of age
B. Patient is aged 6 months through 8 years and has received two or more doses of seasonal
vaccine before July 1, 2015 and has already received one dose of influenza vaccine during the
current influenza season
C. Patient is aged 6 months through 8 years and has received at least two doses of influenza
vaccine during the current influenza season
D. Patient is aged 6 months through 8 years and has received an influenza vaccine dose within the
last 4 weeks
E. Patient is aged 9 years or older and has already received one dose of influenza vaccine this
season
F. Patient or caregiver offered and declined the influenza vaccination
G. Patients with a solid organ transplant (e.g. heart, lung, pancreas, kidney, liver, intestine) or bone
marrow / stem cell transplant during the current hospitalization
H. Patient has an allergy / sensitivity to the vaccine or the vaccine is not likely to be effective due to
the following:
1. Hypersensitivity to eggs or other component(s) of the vaccine
2. Is hospitalized with an episode of acute inflammatory demyelinating polyneuropathy
(AIDP) or Guillian-Barré Syndrome (GBS) or has a history of AIDP or GBS (Neurologist
should determine when patient may again be eligible for vaccination)

3. Has undergone either of the following in the past 6 months: solid organ transplant (e.g.
heart, lung, pancreas, kidney, liver, intestine) OR bone marrow / stem cell transplant
4. Anaphylactic latex allergy (note: the 2013-2014 Fluzone® preparations do not contain
latex)
I. Patient receiving palliative care
J. Patient enrolled in research protocol(s)
K. Patient with planned discharge to hospice care
VI. IIV Vaccine inclusion criteria
A. Patient is 6 months of age or older
B. Patients will been screened for inclusion to protocol based on the UW Health Influenza and
Pneumococcal Vaccination – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline
VII. Pneumococcal Vaccine exclusion criteria
A. Patient younger than 2 years of age
B. Older than 2 years of age and does not have condition/indication for vaccination
C. Patient or caregiver offered and declined vaccine
D. Patient previously received appropriate pneumococcal vaccine(s)
E. Patients 19 years and older who received PCV13 or PPSV23 in the previous 12 months;
additional pneumococcal screening to be evaluated by primary care provider
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

F. Patients 19 years and older who previously received pneumococcal vaccine, but unable to
confirm if PCV13 or PPSV23; patient should follow-up with primary care provider following
discharge
G. Pediatric patient received PCV13 or PPSV23 in previous 8 weeks
H. Hypersensitivity to component(s) of the vaccine
I. Is hospitalized with an episode of acute inflammatory demyelinating polyneuropathy (AIDP) or
Guillian-Barré Syndrome (GBS) or has a history of AIDP or GBS (Neurologist should determine
when patient may again be eligible for vaccination)
J. Bone marrow transplant within the past 12 months
K. Enrolled in clinical trial
L. Patient younger than 19 years of age with asthma and that has no other high risk conditions
M. Planned discharge to hospice care
N. Pregnant
O. Solid organ transplant (e.g. heart, lung, pancreas, kidney, liver, intestine) or bone marrow/stem
cell transplant during the current hospitalization
P. Solid organ transplant (e.g. heart, lung, pancreas, kidney, liver, intestine) within the past 6
months
Q. Receipt of chemotherapy or radiation during this hospitalization or less than 2 weeks prior to
this inpatient hospitalization
R. Receiving comfort measures only
S. Received the shingles vaccine (Zostavax) within the last 4 weeks (PPSV23 only)
T. Received rituximab for a rheumatoid arthritis indication within the previous four weeks
VIII. Pneumococcal Vaccine (PCV13 and PPSV23) inclusion criteria.
A. Patient is 2 years of age or older
B. Patients will been screened for inclusion to protocol based on the UW Health Influenza and
Pneumococcal Vaccination – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline
IX. Pharmacist will document vaccination screening in the electronic medical record
X. Pharmacist will order the vaccine(s) with a frequency of “prior to discharge” and a note to chart order
(“NOTE: Administer all vaccines in the prior to discharge MAR tab”) with a frequency of “prior to
discharge”. When the day of discharge is known, the pharmacist will change the frequency of the note
to chart order to “once,” scheduled on the day of discharge to prompt the nurse to administer the
vaccine(s). The vaccine(s) order will not be changed to avoid billing errors.
XI. Authorized prescribers (within their scope of practice) may initiate or modify vaccine orders outside of
the protocol and may schedule administration at any time

Order Mode: Protocol/Policy, Without Cosign

References:
1. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and Control of Influenza
with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States,
2015-16 Influenza Season. MMWR. Morbidity and mortality weekly report. Aug 7 2015;64(30):818-825.
2. Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent
pneumococcal polysaccharide vaccine among adults aged >/=65 years: recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR. Morbidity and mortality weekly report.
2014;63(37):822-825.
3. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine
among children aged 6-18 years with immunocompromising conditions: recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR. Morbidity and mortality weekly report.
2013;62(25):521-524.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

4. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for
adults with immunocompromising conditions: recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR. Morbidity and mortality weekly report. 2012;61(40):816-819.
5. Nuorti JP, Whitney CG. Prevention of pneumococcal disease among infants and children - use of 13-valent
pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine - recommendations
of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports :
Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control.
2010;59(Rr-11):1-18.
6. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-
valent pneumococcal polysaccharide vaccine (PPSV23). MMWR. Morbidity and mortality weekly report.
2010;59(34):1102-1106.
7. Ahmed F, Temte JL, Campos-Outcalt D, Schunemann HJ. Methods for developing evidence-based
recommendations by the Advisory Committee on Immunization Practices (ACIP) of the U.S. Centers for
Disease Control and Prevention (CDC). Vaccine. 2011;29(49):9171-9176.

Collateral Documents/Tools:
Patients will been screened for inclusion to protocol based on the UW Health Influenza and Pneumococcal
Vaccination – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline. Accessed March 20, 2017.
https://uconnect.wisc.edu/clinical/cckm-tools/content/?path=/content/cpg/infection-and-isolation/name-
97545-en.cckm

Approved By:
UWHC Immunization Task Force: July 2013; March 2017; *March 2017
UWHC Antimicrobial Use Subcommittee: July 2013; January 2015; *March 2017
UWHC Pharmacy & Therapeutics Committee: July 2013; March 2015; *April 2017
UWHC Medical Board: August 2013; April 2015; *April 2017

Effective Date: April 2017

Scheduled for Review: April 2020
‘*Expedited Review Process

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org