Pneumococcal vaccination

WE have a form that the US includes in the chart of every new admit. It has the assessment/criteria for who should receive the vaccine. It has been pre-approved by all drs. It is the admitting nurses responsibility to see that it is filled out and faxed to pharmacy. The form serves as the actual order. We use the same process for the flu vaccine.

We do our admissions on computer. When they answer "no" when asked if they've received the vaccine it triggers a task to the pharmacy. A pharmacists, does the education regarding risks and benefits and if the patient agrees, an order is generated and the nurse administers it.

WE have a form that the US includes in the chart of every new admit. It has the assessment/criteria for who should receive the vaccine. It has been pre-approved by all drs. It is the admitting nurses responsibility to see that it is filled out and faxed to pharmacy. The form serves as the actual order. We use the same process for the flu vaccine

we do the same. it is part of the admission paperwork. If you are over 65, you automatically qualify. If you are 19-64 and live in prison, institution setting, have any chronic heart or lung or kidney disease, are immunocompromised in any way, etc you qualify. there is a section about disqualifications, too, like a temp over 100.4, allergy to eggs, etc the nurse signs and dates it,and selects time for administration and sends it to the pharmacy. As quote states, this is a standing order, no need to hunt a physician down for it.

We have protocol in place and it gets onto the MAR from pharmacy, our problem has been making sure the patient actually gets i before they discharge. Thats where the hurdle has been in our facility. Even with discharge planning, it frequently gets overlooked in the patients rush to get out and the nurses having so many discharges and admissions to do. Sometimes it gets caught sometimes it doesnt.

This is part of our admission protocol as well. If a person is over 65 and does not have any contraindications for the vaccination (listed in the admission screenings) then the computer automatically generates an order for the vaccine.

Interesting thing is . . .I work with at least 3 nurses who refuse to give the vaccine to people for various reasons ranging from "I don't believe in it (?)", to "it makes people sick as dogs so I don't give it". I have seen many vials of the vaccine hanging around in the fridge because they are never given.

Wonder if there are others out there who have experienced the same thing . . .or who don't give the vaccination . . and why??

I know it's different, but I'm in LTC. On admission, res. or family are asked about their last pnuemococcal vaccination. If they can't remember, I call their docs. If the doc doesn't have a record, I call local health dept to see if they have a record. In the last year or so, I've only admitted 1 person who received the vaccine during a hospitalization.

This is part of our admission protocol as well. If a person is over 65 and does not have any contraindications for the vaccination (listed in the admission screenings) then the computer automatically generates an order for the vaccine.

Interesting thing is . . .I work with at least 3 nurses who refuse to give the vaccine to people for various reasons ranging from "I don't believe in it (?)", to "it makes people sick as dogs so I don't give it". I have seen many vials of the vaccine hanging around in the fridge because they are never given.

Wonder if there are others out there who have experienced the same thing . . .or who don't give the vaccination . . and why??

Other than the patient refusing, what acceptable reason is there for failing to administer an ordered medication?

Do these nurses also fail to give B/P medication, insulin, or antibiotics if they don't believe in them, or think they will make people sick as dogs?

Jolie wrote:

Do these nurses also fail to give B/P medication, insulin, or antibiotics if they don't believe in them, or think they will make people sick as dogs?

No . . they obviously can't get away with refusing to give a scheduled medication!! The pneumococcal order is written to be given anytime during the patient's stay. So, it's easy to pass this off to other nurses when you have some sort of "ethical" problem with the vaccination or you don't want to deal with fever or n/v that sometimes accompanies the vaccine.

The weird thing is that the nurses who seem to "not like" the vaccine are some of our most seasoned, experienced and intelligent staff. It makes me wonder "what's wrong with it?" I asked one nurse about this directly "why don't you believe in it??" She just shook her head and walked away stating "I just don't" and wouldn't get into details. . .

That's why I asked if there are others out there who don't like giving this vaccine . . and why . . .what am I missing???

Jolie wrote:

That's why I asked if there are others out there who don't like giving this vaccine . . and why . . .what am I missing???

We don't actually have a process in place that mandates those pts who haven't been immunized to be given the vaccine. But we, as nurses, are suppose to get the vaccine yrly, along with our TB skin test. I personally have refused them repeatedly. Every time I have had the vaccine in the past it has made me sick as a dog. Therefore, I really don't see the point in getting a vaccine that's suppose to keep me from getting sick, when in actuality it makes me sick.

Thank you for your replies. We have the order sheets, etc., We just seem to miss giving the dose. We used to give it on admission, then changed it to the day of discharge, and it was still missed. The process was changed to give the vacc on the 2nd day of the patient's stay. Since it is a one time dose, it falls off the MAR the next day whether the vacc is given or not. Sounds like the problem is widespread.

We also give it the 2nd day of stay. If it gets missed for some reason or another, you will get a nasty-gram from pharmacy unless it is because the pt refused it. Shows up on our patient careplans.....is a good reminder to check and make sure it has been given.

HOw funny this is being discussed now. Just today, I had a pt who i gave a pneumo-vax to, after she was screened and was declaered eligible (she's 86, that alone qualified her). i went into her room, and told her and her daughter about the meds i was giving her (zofran, fentanyl, etc) and said "this is the pneumonia shot" and her daughter goes " she has pneumonia??"