Background: Tetanus vaccinations for wound prophylaxis are routinely administered in emergency departments (ED). Current recommendations from the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) regarding tetanus administration for wound prophylaxis differentiate between the tetanus and diphtheria (Td) and the tetanus, diphtheria, acellular pertussis (Tdap) formulations and when they should be administered. Lack of knowledge regarding these recommendations, different formulations, and techniques to locate patient immunization history can lend to increased duplicate and inappropriate vaccinations. Objective: The purpose of this prospective, interventional study with a historical control was to evaluate the impact of a pharmacy-driven education series on the proportion of duplicate and inappropriate tetanus vaccinations administered in a level I trauma center ED. Methods: Three months of tetanus vaccinations administered in the ED after this education were analyzed and compared with a historical control. The primary outcome is the percentage of vaccinations considered duplicates (previous vaccination within the past 5 years) when patients’ medical record was reviewed for immunization history. Secondary end points include the percentage of vaccinations considered nonadherent (according to current CDC-ACIP guidelines), the total cost of all duplicate vaccinations, and the percentage of vaccination orders that had the wrong formulation administered. Results: The percentage of duplicate vaccinations decreased from 9.9% (25 vaccinations) to 5.5% (14 vaccinations) (P = .067) from the preintervention group to the postintervention group. Nonadherent vaccinations compiled 3.6% versus 2.8% of the vaccinations (P = .611) and incorrect formulations given were 18.2% versus 11.4% (P = .176) in the preintervention and postintervention groups, respectively. Conclusion: The study suggests that multiple formulations of tetanus vaccinations and fragmented documentation of immunizations increase the prevalence of medication errors related to tetanus vaccinations. It also indicates that interventions more enduring than education are required to prevent these errors.
Dumpster Diving in the Emergency Department: Quantity and Characteristics of Waste at a Level I Trauma Center
