BACKGROUND:
S. pneumoniae is the fourth most common bacteria isolated from the sputa in patients with cystic fibrosis (CF). Patients with CF lack the ability to properly clear encapsulated bacteria and are at increased risk for severe pneumococcal disease. More importantly, an estimated 17% to 39% of CF patients did not exhibit adequate anti-pneumococcal antibody levels.

OBJECTIVE:
To determine if documenting 23-valent polysaccharide pneumococcal vaccine (PPV 23) on a cover sheet in the medical chart would increase vaccination rates.

METHOD:
We selected only active patient (seen within the previous 12 months) medical charts for retrospective review. One hundred patients met our inclusion criteria and their charts were reviewed to assess current PPV 23 immunization status. Beginning in July of 2002, the PPV 23 immunization status was printed on a cover sheet at the front of the chart. If the patient had not previously received one dose of PPV 23 since age 2, we either vaccinated them in clinic or recommended that they receive the vaccine from another health care provider. Updated cover sheets are then printed for each subsequent clinic visit.

RESULT:
Prior to July 2002, only 13% of our patients had ever received a PPV 23 vaccination. At the end of May 2003, 86% of our patients had either received a PPV 23 vaccination (69%), received education and the choice to receive the PPV 23 vaccine (12%) or declined to receive the PPV 23 vaccine (5%).

CONCLUSION:
Pneumococcal disease is the leading cause of vaccine preventable death in the U.S. Despite being licensed in the U.S. since 1977, pneumococcal vaccination rates remain very low especially in those with high risk medical conditions. The results of this study demonstrate the clinical utility of provider reminders via a cover sheet and assessing performance via retrospective chart review.

LEARNING OBJECTIVES: