Hepatitis B vaccination: addressing a drug-related problem in hemodialysis outpatients with a collaborative initiative.
The CDC recommends that all hemodialysis (HD) patients be vaccinated against hepatitis B virus (HBV). In 1999, only 39 of our 134 (29%) HD patients had received HBV vaccine. Since the vaccine is indicated for all HD patients, this presented a drug-related problem (DRP): indication without treatment. In response, nurses and pharmacists initiated a proactive HBV vaccination program.


METHODS
An immunization protocol based on then current CDC recommendations was developed. HBV vaccine (40 mcg i.m.; at 0, 1 and 6 months) was administered to consenting HD patients. Anti-hepatitis B surface antibody (anti-HBs) titers were monitored and booster doses were given per the protocol.


RESULTS
By August 2001, all consenting HD patients (n = 110) had received > or = 1 dose of HBV vaccine and 90 (81.8%) had either received a full course (> or = 3 doses) or had received > or = 1 dose and developed a positive anti-HBs titer (> or = 10 mIU/mL). Of these 90 patients, 52 (58%) developed a positive anti-HBs titer, 33 (37%) responded to < or = 3 doses, and 19 (21%) following a booster. The DRP was significantly improved.


CONCLUSIONS
Given CDC guidelines, HBV vaccine should be offered to all HD patients. This initiative demonstrates that with concerted effort all consenting HD patients can receive HBV vaccination, thereby addressing an important DRP.
Elwell
Rowland J
RJ
Albany College of Pharmacy, Albany, NY, USA.
Neumann
Marianne
M
Manley
Harold J
HJ
Carpentier
Louise
L
Bailie
George R
GR
D000465:Algorithms; D003299:Cooperative Behavior; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000627:therapeutic use*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010596:Pharmacy Technicians; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D006435:Renal Dialysis / Q000451:nursing*
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines