Peer-reviewed article

Examining prescribing, timeliness and data recording of immunisations onto a national electronic immunisation register for inpatients at a tertiary paediatric hospital

Selina Lim, Vince Martino, Natasha Andres, Sein Ron Lena Ng, Monir Jalili et al. · 1 Oct 2021

Abstract

Vaccines are one of the greatest public health interventions to date and an effective means of reducing the spread of vaccine-preventable diseases in the community.1 Vaccines are Schedule 4 (prescription only) medications,2 yet little is known about the quality of vaccine prescribing in a hospital setting. The aim of this study was to investigate the quality and adherence of inpatient immunisation prescribing, as well as timeliness and recording of immunisations onto the national immunisation register, within a tertiary paediatric hospital setting. We conducted an observational, retrospective review of inpatient immunisations at Perth Children’s Hospital from July 2018 to February 2019. Inpatient vaccine prescriptions for children aged 16 years or less were obtained from hospital medical records, prescription charts and pharmacy dispensing databases. Vaccine prescription dose, route, documentation, timeliness and recording onto the electronic national immunisation registry were assessed against the state-funded immunisation schedule, the National Safety and Quality Health Service Standards (NHSQHSS) for Medication Safety,3 and national guidelines, the Australian Immunisation Handbook.4 Overall, 130 vaccine prescriptions were identified; 20 were excluded due to unavailability of medication charts. Of the 110 vaccine prescriptions included, 10% (n = 11) contained one prescription drug error. Of these, seven prescriptions (64%) had the incorrect dose prescribed and all of these were related to the influenza vaccine, aged-based dosing. This included identification of three episodes of under-dosing for age and four instances of over-dosing for age for the influenza vaccine. Two prescription errors were corrected by ward-based pharmacists and subsequently correct vaccine administration was performed. The remaining prescription errors were not detected by the ward pharmacist due to pharmacy resource constraints and were recommended for reporting through the hospital clinical incidence management system. Three prescriptions (3%) had incorrect route of administration (relating to inadvertent SC administration of IM preparations and vice versa) and one had duplicate vaccine administration. Seventeen prescriptions (13%) had abbreviations considered unacceptable for use by NHSQHSS (most frequently, Ṫ), and one prescription was deemed illegible. Nineteen patients (17%) were overdue vaccinations by one month or more, according to the child’s age and the state-funded immunisation schedule. Recording of the vaccine administrated onto the electronic registry was complete in just under half (46/96, 48%) of children immunised as inpatients. This preliminary research conducted at a single hospital site identified that the majority of prescriptions were adherent to prescribing guidelines. A lower proportion of inpatients were up to date with routine immunisations (83%), compared with the overall state immunisation rate of more than 91%.4 Reasons for this are likely multifactorial5 and education around false contraindications to vaccination, as well as promoting timeliness with immunisations, could assist. The value of hospital-based pharmacists was demonstrated, with correction of two prescription drug errors. Age-based dosing for vaccines, as highlighted from this cohort, is a significant risk factor for vaccine prescribing errors, and supports the move to non-aged-based influenza dosing for children nationally in 2020.2 With almost one out of every two children administrated a vaccine as an inpatient not recorded onto the electronic registry, further targeted education strategies are required, and a dedicated immunisation service can assist.5 Easily accessible prescribing information for vaccines in immunisation resources could also support prescribers.4 Ethics approval was obtained from the Child and Adolescent Health Service Ethics Committee (GEKO approval 31454). The authors declare that they have no conflicts of interest. The data are not publicly available due to privacy or ethical restrictions.