REPORT: October/November 2006

Ask the Experts

Immunizations for hospitalized patients

Q.: Our hospital has a new policy that requires us to offer the influenza and pneumococcal vaccination to all persons over the age of 65 who are admitted to the hospital. I work in the ICU and many of my elderly patients are compromised or in serious condition. Is it appropriate for them to receive the vaccine?

A.: A new state law, which took effect on Oct. 24, requires all general hospitals to implement a policy for offering influenza and pneumococcal vaccinations to admitted persons age 65 and older. The policy should include procedures ensuring that the individuals or their guardians receive information regarding the risks and benefits of the vaccines, and that patients be assessed for contraindications.

The two contraindications for receiving either vaccine include: 1) a history of anaphylaxis to the vaccine or any of its components, such as eggs, or 2) the presence of a moderate-to-severe acute febrile illness. Both vaccines are recommended for adults with chronic medical conditions, especially cardiac, pulmonary, or metabolic disorders. Many patients admitted to an ICU are likely candidates for the immunizations because of their compromised condition, unless they are contraindicated as described above.

As always, RNs have a duty and right to question any medical order they feel may be inappropriate for a particular patient. If you have concerns about whether these immunizations are appropriate for your patient, ask for clarification from the patient’s primary care provider. As patient advocates, RNs are responsible to ensure the safety and appropriateness of any intervention imposed on patients, especially while they are in a compromised state.