Should we test for tetanus immunity in all emergency department patients with wounds?

McVicar, Jane

doi:10.1136/emermed-2012-201193

Cited by 18 publications

(8 citation statements)

References 9 publications

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“…The active involvement of parents in matters of vaccine prevention may contribute towards restoring trust (Oyo-Ita et al, 2011, Fadda et al, 2015, Odone et al, 2015). Many parents have difficulties recalling the vaccination status of their child, which was shown by several studies earlier and confirmed by the current evaluation (Miles et al, 2013, McVicar, 2013). Parents need encouragement and support when keeping track of the vaccination record of their children (Thorpe et al, 2016, Varkey et al, 2010).…”

Section: Discussionsupporting

confidence: 80%

Educating parents about the vaccination status of their children: A user-centered mobile application

Seeber

Conrad

Hoppe

et al. 2017

Preventive Medicine Reports

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Parents are often uncertain about the vaccination status of their children. In times of vaccine hesitancy, vaccination programs could benefit from active patient participation. The Vaccination App (VAccApp) was developed by the Vienna Vaccine Safety Initiative, enabling parents to learn about the vaccination status of their children, including 25 different routine, special indication and travel vaccines listed in the WHO Immunization Certificate of Vaccination (WHO-ICV). Between 2012 and 2014, the VAccApp was validated in a hospital-based quality management program in Berlin, Germany, in collaboration with the Robert Koch Institute. Parents of 178 children were asked to transfer the immunization data of their children from the WHO-ICV into the VAccApp. The respective WHO-ICV was photocopied for independent, professional data entry (gold standard). Demonstrating the status quo in vaccine information reporting, a Recall Group of 278 parents underwent structured interviews for verbal immunization histories, without the respective WHO-ICV. Only 9% of the Recall Group were able to provide a complete vaccination status; on average 39% of the questions were answered correctly. Using the WHO-ICV with the help of the VAccApp resulted in 62% of parents providing a complete vaccination status; on average 95% of the questions were answered correctly. After using the VAccApp, parents were more likely to remember key aspects of the vaccination history. User-friendly mobile applications empower parents to take a closer look at the vaccination record, thereby taking an active role in providing accurate vaccination histories. Parents may become motivated to ask informed questions and to keep vaccinations up-to-date.

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Section: Discussionsupporting

confidence: 80%

Educating parents about the vaccination status of their children: A user-centered mobile application

Seeber

Conrad

Hoppe

et al. 2017

Preventive Medicine Reports

View full text Add to dashboard Cite

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“… 6 A similar study of 200 adults showed that almost 40% of them had incorrect recall of their tetanus vaccination status. 7 However, one contrasting adult study in France did find that patients self-reported that their tetanus vaccines were up to date correctly about 96% of the time. 8 It may be interesting to pursue a prospective study in the pediatric ED comparing patients’/parents’ memories, EHR, and state vaccination registry to a tetanus rapid immunochromatographic test.…”

Section: Discussionmentioning

confidence: 99%

Using an Online Vaccination Registry to Confirm Tetanus Status in Children with Tetanus-prone Wounds

Zeretzke-Bien

McCall

Wylie

et al. 2020

WestJEM

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Introduction Tetanus vaccination status is an important consideration for emergency physicians managing patients with tetanus-prone wounds. Physicians must identify at-risk patients, but vaccination histories are often unknown and commonly lack documentation. The study objective was to determine the potential impact of an online immunization registry (Florida SHOTS – State Health Online Tracking System) on the appropriate administration of tetanus prophylaxis for pediatric patients managed in the emergency department (ED). Methods We conducted a retrospective review of all patients less than 18 years old who received ED tetanus prophylaxis at two separate sites between January 2011–May 2015. The Florida SHOTS database was accessed to determine vaccination status for each patient in the study group at the time of the encounter. We compared vaccination status for each patient, as documented in the electronic health record (EHR), with Florida SHOTS data to determine whether tetanus prophylaxis was indicated. The proportion of patients receiving tetanus prophylaxis in the ED, who were subsequently identified as up to date with tetanus vaccination per Florida SHOTS, was determined. Results We identified 743 patients who received ED tetanus prophylaxis. Forty-three (6%) were listed as “up to date” on the EHR and 656 (93%) were listed as “not up to date.” In comparison, 209 (30%) of the study group were identified as “up to date” via Florida SHOTS, and 477 (70%) were not. We accessed the Florida SHOTS record retrospectively to determine whether the vaccine was required. It was determined that 174 (25%) of the patients received tetanus prophylaxis unnecessarily as they were already up to date per Florida SHOTS documentation. Conclusion Twenty-five percent of patients vaccinated for tetanus in the ED could have been spared if Florida SHOTS data had been used by providers at the time of the encounter. Access to Florida SHOTS provides valuable information regarding vaccination status that impacts patient care and resource utilization in the ED.

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“…Physician notifications regarding tetanus booster evaluation in primary care settings have been shown to be beneficial; however, as not all wounds require tetanus vaccinations, it is unlikely that interventions similar to this will be advantageous in an ED setting. 17 Another study ascertained the cost benefit of testing wounded ED patients for tetanus immunity prior to administration of any tetanus prophylaxis. 17 An intervention such as this would remove the need to locate patient immunization history or make prophylaxis decisions based on patient recall; however, instituting a blood test (albeit finger-prick) with every patient presentation involves cost and time commitments.…”

Section: Discussionmentioning

confidence: 99%

“…17 Another study ascertained the cost benefit of testing wounded ED patients for tetanus immunity prior to administration of any tetanus prophylaxis. 17 An intervention such as this would remove the need to locate patient immunization history or make prophylaxis decisions based on patient recall; however, instituting a blood test (albeit finger-prick) with every patient presentation involves cost and time commitments. Electronic notifications, linking immunization history with vaccination orders, and requiring scanning of products upon removal from medication dispensing machines are hard-stop interventions that could be implemented to decrease duplicate vaccinations and inappropriate formulation administration, respectively.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Pharmacy-Driven Education on the Amount of Appropriately Administered Tetanus Vaccines in the Emergency Department

2018

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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.

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Should we test for tetanus immunity in all emergency department patients with wounds?

Cited by 18 publications

References 9 publications

Educating parents about the vaccination status of their children: A user-centered mobile application

Educating parents about the vaccination status of their children: A user-centered mobile application

Using an Online Vaccination Registry to Confirm Tetanus Status in Children with Tetanus-prone Wounds

The Effect of Pharmacy-Driven Education on the Amount of Appropriately Administered Tetanus Vaccines in the Emergency Department

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