Reflection: appropriateness of ADT booster vaccines administered in the emergency department
Julie J. Kalf
BPharm (Hons) | Pharmacist, Cairns Hospital | Julie.Kalf@health.qld.gov.au
Tetanus is a rare but life-threatening condition, with 14 deaths recorded between 1997 and 2016 in Australia and the current case-fatality rate reported to be about 2%.1, 2 The emergency department (ED) serves as a critical point for identifying patients at risk of tetanus prone wounds and providing timely prophylaxis and treatment to prevent serious complications. Many unique challenges are encountered when assessing the need for tetanus boosters, including limited access to patient health records, such as My Health Record (MHR), limited access to vaccination records through the Australian Immunisation Record (AIR), patient’s own recollection of immunisation currency, and patient hesitancy toward vaccines. Considering the challenges a prescriber may encounter when assessing a patient’s risk of tetanus, it raises the question; how many ADT Booster vaccines are being inappropriately prescribed and administered in the ED?
Recognising the importance of ADT Booster vaccines in our large regional hospital in North Queensland, I embarked on an audit to assess the appropriateness of these vaccines administered in our ED. While aiming for a month-long analysis, I encountered many challenges familiar to many clinicians, including difficulties with accessing health records and limitations that come with being a paper-based prescribing hospital, as well as challenges associated with maintaining a clinical workload and time constraints. Additionally, I had already invested several months in a different project that I had to unfortunately abandon. This audit was able to provide more evidence to enact change in a shorter time frame. The abrupt change in research project proved difficult as I struggled with the motivation to research and collate data in my personal time, however I leveraged the experience to hone my research skills and data analysis techniques for building a valuable foundation. After much turmoil, I settled with auditing only two weeks of data which was disappointing as I acknowledge that this is not an accurate reflection of average usage. Additionally, while findings showed that one in three vaccines were inappropriate, the overall annual cost extrapolated from the two-week snapshot did not seem incredibly significant. This therefore may be considered non-concerning or irrelevant to many of our prescribers.
While initially navigating the intricacies of the local ethics approval process, I found myself lacking readily available guidance and had to seek advice and guidance from pharmacists who were not in the research space. Fortunately, the recent appointment of a new education and research pharmacist has proved invaluable. Their extensive knowledge and unwavering support had significantly propelled my project forward, mitigating further delays in data collection and potential publication. With renewed confidence, I have begun exploring publication possibilities, under their encouraging mentorship. We have identified that ED-focused publications or conferences with exposure to prescribers may increase the impact of my findings. Furthermore, they have recommended engaging with my ED prescribing colleagues to garner valuable insights on project findings and potential publication options.
Despite this project being one I was not initially deeply passionate about; I did thoroughly enjoy returning to research and it has rekindled my enthusiasm for further projects. After completing this project and discussions with the new research pharmacist, I have been encouraged to consider pursing my last project idea. To best equip myself for this endeavour however, I plan to enrol in professional development opportunities to develop my research skills, such as the courses offered by SHPA. I also intend on discussing roster flexibilities with my new Team Leader to facilitate dedicated time for data collection during the project’s active phase.
References
- Australian Government: Department of Health and Aged Care. Australian Immunisation Handbook. Tetanus. Canberra: Commonwealth of Australia; 2023. Available from <https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/tetanus>. Accessed 16 November 2023.
- Australian Institute of Health and Welfare (AIHW). Tetanus in Australia. Canberra: Australian Institute of Health and Welfare; 2018. Available from <https://www.aihw.gov.au/getmedia/f877a2da-23e3-4516-948f-df05ca7ceb43/aihw-phe-236_Tetanus.pdf.aspx>. Accessed 16 November 2023.