Background: Influenza vaccination will have added importance this winter given the possibility of further waves of the COVID-19 pandemic. This study examines the impact of an electronic medical record (EMR) reminder on influenza vaccine uptake among eligible hospital inpatients. Methods: We included a convenience sample of 750 adults (median age 77 years) who are eligible for influenza vaccination (⩾65 years and/or length of stay >30 days). A live electronic dashboard identified patients eligible for vaccination, prompting reminders sent to the clinical teams via the EMR. Results: The EMR reminder was associated with almost a 50% higher likelihood of vaccination after adjusting for other covariates (odds ratio 1.48 (95% confidence interval 1.00–2.20); p = 0.048). Discussion: Reminders sent to the clinical team via the EMR appear to be an effective means of increasing vaccine uptake and should be considered as part of this year’s drive to vaccinate eligible patients in hospital.

Background Influenza vaccination, particularly for vulnerable, older adults, will have added importance this winter given the possibility of further waves of COVID-19 pandemic. Previous interventions at the study site noted poor awareness on the need for inpatient Influenza vaccination1. This study examines a vaccination reminder process using an electronic patient record (EPR) to identify high-priority eligible inpatients. Methods The study site is a 900-bed university teaching hospital with all clinical notes accessed via an EPR. We included a convenience sample of 750 adults aged≥50 years (mean age 75.9 +/− 0.4 years, 48% female) and high-priority for influenza vaccination (Age > 65 years and/or length of stay (LOS) >30 days) from October 1st 2020 to January 12th 2021. A live electronic dashboard identified eligible inpatients for vaccination, prompting vaccination reminders to the clinical teams via the antimicrobial pharmacist. Data was collected retrospectively. Logistic regression models reporting odds ratios were used to assess the association of these reminders with vaccine uptake. Results Over one third (35%, 264/750) of high-priority patients received the Influenza vaccine while inpatients, including 40% aged ≥80 years. The reminder was sent on 41% (305/750) of patients and was associated with an almost 50% higher likelihood of vaccination after adjusting for other covariates (Odds Ratio 1.48 (95% CI 1.00–2.20); p = 0.048). Other factors independently associated with vaccination were advancing age (Odds Ratio 2.69 (95% CI 1.12–6.47) for age ≥ 80 years); LOS (4% higher likelihood of vaccination for every additional day in hospital) and admission under geriatric medicine (Odds Ratio 3.71 (95% CI 2.45–5.62) when compared to other specialities). Conclusion Our study shows relatively low uptake of inpatient Influenza vaccination and strategies to improve uptake are required. Reminders sent to clinical teams using the EPR appear to be an effective means of increasing Influenza vaccination and should be considered as part of this year’s inpatient vaccination drive.

A 54-year-old gentleman presented with necrotic cutaneous areas on his toes and fingers after failure of his kidney transplant requiring a return to hemodiafiltration after 15 years of adequate allograft function. He had a background history of tertiary hyperparathyroidism, rheumatoid arthritis, Addison's disease, and recurrent pulmonary emboli. X-rays were performed of his affected hand and foot (Figures 1 and 2). The patient required amputation of multiple digits due to ischemia caused by calcific uremic arteriolopathy (CUA). In addition to parathyroidectomy, he commenced intravenous sodium thiosulfate after dialysis, stopped warfarin, and had an intensification of his hemodiafiltration adequacy, with increased control of his serum calcium and phosphate (1). At the time of writing, the patient's CUA had not progressed extensively since diagnosis in 2013, and he remains on intermittent hemodiafiltration.