Immunisation status screening for pneumococcal vaccination (23vPPV) in patients over 65 years of age presenting to the emergency department: A mixed methods study.

Abstract

Pneumonia is one of the most common reasons patients over the age of 65 years present to the Emergency Department (ED). There is a 23-valent pneumococcal vaccine (23vPPV) available under the National Immunisation Program (NIP) that has demonstrated 71% effectiveness in preventing the morbidity and mortality associated with Invasive Pneumococcal Disease (IPD) for adults aged over 65 years. Despite this, vaccine coverage for pneumococcal disease is only 56% in Australia. Immunisation status screening is a behaviour that includes confirming a patient’s vaccination history by asking if they are up to date with all required vaccinations or checking medical records for evidence of previous vaccination. The aim of this study was to explore the behaviours and attitudes of nurses regarding immunisation status screening for patients over 65 in the emergency department in order to inform future interventions to increase screening, and therefore pneumococcal immunisation uptake in this age group. This mixed methods study was comprised of qualitative short semi-structured interviews (n=9) and surveys (n=82) completed by emergency nurses working across a suburban health district in Sydney New South Wales. Questions concerned the knowledge, practices and attitudes towards immunisation status screening and were structured to Michie et al.’s (2011) COM-B model (capability, opportunity and motivation to change behaviour). A thematic analysis was conducted, guided by Vaismoradi et al.’s (2016) methods for qualitative analysis. The findings from these interviews were used to enhance the development of a survey which determined the views of the emergency nurses regarding immunisation status screening, including suggestions for future practice. The survey was administered to a larger representative group of emergency nurses within the same locality and a qualitative/content analysis was conducted. Five key findings emerged. These included: 1) the significance of routinisation in nursing practice to increase immunisation status screening; 2) that emergency nurses require focused education on immunisation status screening and vaccination for patients over the age of 65 years; 3) the paediatric vaccination heuristic can be used to influence immunisation status screening for the elderly; 4) that emergency departments and emergency nurses can accommodate immunisation status screening for the elderly, but that environmental changes are required; and, 5) encouraging emergency nurse to think critically can increase the incidence of immunisation status screening. These findings resulted in several recommendations to increase immunisation status screening for the elderly in the emergency department, and therefore overall pneumococcal vaccination uptake. These prominently included the provision of education, enablement in the workplace, as well as environmental restructuring. Future research aims at implementing these recommendations.