A pneumococcal vaccination program helped a hospital meet regulatory expectations for vaccination of patients with CAP and vaccinated many other at-risk patients.

Despite the availability of effective prevention and treatment measures, pneumococcal infection continues to be a significant source of morbidity and mortality. This study evaluated the impact of incorporating the assessment of pneumococcal vaccination status into selected critical pathways of at-risk patients. In a prospective, nonblinded, parallel-group trial, adult inpatients on four critical pathways were randomized into intervention or control groups. Nursing personnel screened all patients for previous pneumococcal vaccination. A pharmacist would then screen all patients for pneumococcal disease risk factors. If vaccination was indicated in the intervention group, the pharmacist educated the patient and/or caregiver, obtained patient consent, and asked the patient's physician for permission to immunize. No further action was undertaken with the control patients. A total of 231 patients were enrolled in the study (107 intervention, 124 control). Initial immunization rates were 46.8% in the control group and 56.1 % in the intervention group. Forty-six patients in the control group and 39 patients in the intervention group were eligible (unvaccinated with indication) for vaccination. Thirty-two (82.1%) of the patients in the intervention group were counseled and 19 (59.4%) were vaccinated. The overall vaccination rates were 73.8% in the intervention group and 56.1% in the control group (P < 0.001). Results indicate that incorporating assessment of pneumococcal immunization status into critical pathways is an effective way to improve immunization rates.

T he two most recent American Society of Health-System Pharmacists (ASHP) national surveys 1,2 of pharmacy practice in hospital settings defined practice models as "how pharmacy department resources are used to provide patient care services. This includes how pharmacists practice and what services are provided in the care of patients, the role of pharmacy technicians in supporting patient care, and the use of automation and technology in the medication-use process." 2 For the profession to achieve consensus and consistency, it is critical to establish a clear taxonomy of terms to describe our practice models. The authors of the aforementioned ASHP surveys have proposed terminology to describe what are believed to be the three most commonly used pharmacy practice models. 1,2 These definitions are general, and we recognize that actual practice in most hospitals involves a blend of these models.Drug-distribution-centered model. Anderson 3 noted that "the traditional structure of most pharmacy departments is built around drug distribution, acquisition, and control." In this model, medication distribution and the processing of medication orders constitute the singular focus of the pharmacy department. There is little proactive involvement of pharmacists in medication selection or monitoring. In most cases, pharmacists are rel-64111 (twoods@saint-lukes.org).

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