BACKGROUND:
Nationally changes in pharmacy regulations have revolutionized the role of outpatient pharmacists to include vaccine administration. However, for hospital pharmacists, primary roles in immunization include that of educator and facilitator. With collaborative practice legislation approved in 2002 we had the opportunity to reevaluate the role of inpatient pharmacists at Yale-New Haven Hospital.

OBJECTIVE:
In 2001, at our 944 bed tertiary care hospital, pharmacy coordinated a standardized influenza and pneumococcal vaccination assessment and protocol order set program to improve vaccination rates in all elderly and high-risk inpatients. Although documentation of vaccine assessments have improved from <10 % to >90% and pneumococcal vaccination orders increased by 22 fold, we discovered a patient population that consistently fell below target goals. The objective of our project was to utilize collaborative practice legislation to empower pharmacists to ensure all patients admitted with community acquired pneumonia were assessed for pneumococcal vaccination status and eligible patients vaccinated prior to discharge.

METHOD:
An interdisciplinary team agreed to pursue a collaborative practice agreement to expand the pharmacist role as vaccinator to help address deficiencies in this patient population. Data collected for national quality standards will serve as baseline and ongoing performance measures.

RESULT:
From June through September 2003, a collaborative practice agreement was submitted and approved by the Medical Board and Pharmacy and Therapeutics Committee. Formal staff education and training occurred throughout September and nursing education specialists coordinated competency assessment validation efforts in October. Program implementation commenced in December 2003. Daily work process includes the following: review of automated reports by diagnosis and antibiotics uses to treat CAP, patient vaccination assessments, documentation of assessment status and vaccination needs via a chart sticker, and vaccination of eligible patients.

CONCLUSION:
Collaborative practice legislation offers the hospital pharmacist an opportunity to increase vaccination assessment and administration rates.

LEARNING OBJECTIVES:
Describe impact of collaborative practice agreement for inpatient environment.