Vaccinations are a Critical Preventive Vaccinations are a critical preventive health measure and are routinely recommended from an early age. Indeed, the first hepatitis B vaccine in the series can be administered within 12 to 24 hours of birth.
Vaccinations are a Critical Preventive Vaccinations are a critical preventive health measure and are routinely recommended from an early age. Indeed, the first hepatitis B vaccine in the series can be administered within 12 to 24 hours of birth.1 While children receive many vaccinations during routine pediatric visits, adults typically receive vaccinations from a primary care provider (PCP) or at a community pharmacy. In 2018, nearly 70% of adults received a flu vaccine from a doctor or retail health clinic.2 In addition to these locations, vaccinations can also be provided in hospitals and emergency departments (EDs), which provide a safety net for those who would otherwise not have access. While most vaccines are administered by nurses in the hospital setting, there is still a role for the hospital pharmacist. This article examines the role of hospital pharmacists in administering and supporting vaccinations, including in inpatient, emergency and outpatient settings.
Vaccination support in the intramural setting
Many hospitals are part of larger health care systems, including traditional inpatient, emergency and emergency centers, ambulatory clinics, pharmacies and private doctors’ offices. Health systems generally follow 1 system-wide medication formulary. Hospital pharmacists are integral members of pharmacy and therapeutic committees, and as medication experts, they often guide formulary decisions.3 Based on their knowledge and clinical expertise, pharmacists can be called upon to manage formulary placement of vaccines. For example, influenza and pneumococcal vaccines are 2 common vaccines administered to hospitalized patients. Pharmacists can be involved in programming clinical decision support interventions into electronic health records to identify patients who may be candidates for these vaccines. Potential clinical decision support interventions may be standing orders or collaborative agreements.4 Hospital pharmacists can also provide vaccinations to health system staff and advise hospitalized patients who refuse vaccination.5
In addition to the vaccination of patients or employees, hospital pharmacists can also be called upon to implement and monitor mass vaccination clinics.6 For example, based on their experience providing pop-up flu vaccination clinics to workers during the COVID-19 pandemic, hospital pharmacists were able to set up vaccine clinics and educate about COVID-19 vaccines.7 Inpatient vaccination has proven to be an effective means of delivering COVID-19 vaccine doses and booster doses, and hospital pharmacists played an integral role in both the planning and delivery of these vaccines.8.9
Another unique role for hospital pharmacists is to identify patients with asplenia as a result of trauma, surgery, or medical history.10 Patients who do not have a functioning spleen are at risk of serious infection from encapsulated bacteria, and Haemophilus influenzae type b, meningococcal ACWY, meningococcal type B, pneumococcal and annual influenza vaccines are recommended for these patients. Hospital pharmacists can identify patients who need these vaccines and administer the vaccines while these patients are in the hospital or refer them to colleagues for follow-up after discharge.
Hospital pharmacists can also play an important role in tailoring vaccines. Vaccine reconciliation is important because patients can receive vaccines in different healthcare settings. As with medication coordination, nurses ask about vaccinations during screening interviews; however, the patient’s memory of vaccinations may be inaccurate.11 Evidence has shown that implementing a multidisciplinary approach where nurses work with pharmacy staff and use protocols to identify and follow up patients who are eligible for vaccines can increase the rate of inpatient vaccinations.12.13 In addition, providing pharmacists with access to state vaccination information systems could make it easier to maintain more complete vaccination records, at least for vaccines administered within the same state.12
Vaccination support at the emergency room
The ER is another area where hospital pharmacists can be involved in vaccination efforts. About 25% of Americans do not have PCP14 and thus can use the ED for routine care. When a person is in the emergency room, there is an opportunity for education and preventive vaccinations, especially if the patient does not have PCP. ED visits can be a pathway to successful flu vaccination programs,15 COVID-19,16.17 and hepatitis A.18 Hospital pharmacists can administer the first vaccine doses and play a key role in coordinating appointments for individuals to receive subsequent doses of multiple-dose series. These vaccine efforts could be applied to other disease outbreaks or pandemics.
Immunization Support in Outpatient Clinics
Pharmacists working in outpatient clinics also recommend vaccines, educate about vaccines and administer vaccinations. Patients may experience improved continuity during the transition of care from the inpatient or emergency room setting to the outpatient clinic, especially when the outpatient clinic is part of the same health system. Also, patients can have better insurance coverage when they visit an outpatient clinic by taking advantage of outpatient or pharmacy benefits, and such visits can generate income for the facility.
A developing niche for outpatient pharmacists is the establishment of vaccine clinics for patients about to undergo immunosuppressive therapy.19 With the increasing use of monoclonal antibodies and other immunosuppressive drugs for a variety of diseases associated with immune system dysfunction (e.g., Crohn’s disease, psoriasis, multiple sclerosis), pharmacists are poised to screen patients and make recommendations. do about vaccines, especially before patients start immunosuppressive medications.
While the administration of vaccines has not traditionally been seen as part of the responsibilities of hospital pharmacists, their knowledge and experience in dispensing vaccines allows pharmacists to assist with vaccination in many ways and in different healthcare settings. As hospitals continue to expand and evolve towards health systems and sharing responsibility for patient care, hospital pharmacists will continue to expand their role with regard to vaccinations.
1. Vaccination schedule for children and adolescents. Age Recommendations
18 years or younger, United States, 2022. Centers for Disease Control and Prevention. Updated Feb 17, 2022. Accessed May 13, 2022. https://www. cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
2. Amin K, Rae M, Artiga S, Young G, Ramirez G. Where do Americans get vaccines and how much does it cost to administer them? Peterson-KFF Health System Tracker. February 12, 2021. Accessed May 13, 2022. https://www.healthsystemtracker.org/chart-collection/where-do-americans-get-vaccins-and-how-much-does-it-cost-to-administer – them/
3. Ciccarello C, Leber MB, Leonard MC, et al. ASHP Guidelines for the Pharmaceutical and Therapeutic Commission and the Formulary System. Am J Health System Pharm† 2021;78(10):907-918. doi:10.1093/ajhp/zxab080
4. Orenstein EW, ElSayed-Ali O, Kandaswamy S, et al. Evaluation of a clinical decision support strategy to increase seasonal flu vaccination in hospitalized children before hospital discharge. JAMA Netw Open† 2021;4(7):e2117809. doi:10.1001/jamanetworkopen.2021.17809
5. Queeno BV. Evaluation of the acceptance rate of inpatient flu and pneumococcal vaccination with pharmacist education. J Pharm Pract† 2017;30(2):202-208. doi: 10.1177/0897190016628963
6. Gregory N. Pharmacy students play a critical role in mass vaccination against COVID-19. Am J Health System Pharm† 2021;78(8):662-664. doi:10.1093/ajhp/zxab061
7. Andrade J, Slaby M, DeAngelis J, et al. Implementation of a pharmacist-led COVID-19 vaccination clinic in a teaching hospital. Am J Health System Pharm† 2021;78(12):1038-1042. doi:10.1093/ajhp/zxab135
8. Freiser D, Roca M, Chung T, et al. The evolution of a hospital-based COVID-19 vaccination program for inpatients. NEJM Catal Innov Care Deliv† 2022;3(2). doi.org/10.1056/CAT.21.0340
9. Berger RE, Diaz DC, Chacko S, et al. Implementation of an inpatient COVID-19 vaccination program. NEJM Catal Innov Care Deliv† 2021;10.1056/CAT.21.0235. doi:10.1056/CAT.21.0235
10. Scherrer LA, Benns MV, Frick C, et al. Impact of a pharmacist-led intervention on adherence after splenectomy in trauma patients. Trauma† 2020;22(4):273-277. doi: 10.1177/1460408619895695
11. Van Heiden S, Carrico RM, Wiemken TL, et al. Level of recall bias regarding pneumococcal vaccination history in adults hospitalized with community-acquired pneumonia: results from the University of Louisville Pneumonia Study. Univ Louisville J Resp Infect† 2017;1(4):9-12. doi:10.18297/jri/vol1/iss4/3
12. Baucom A, Brizendine C, Fugit A, Dennis C. Evaluation of a pharmacy-to-dose pneumococcal vaccination protocol in an academic medical center. Ann Pharmacother† 2019;53(4):364-370. doi: 10.1177/1060028018805439