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05/10/17 JR -- Adult Post Splenectomy vaccines - review

From: Jerry Robinson Pharm.D.
To: Pharmacists
Sent: Wednesday, May 10, 2017 3:50:14 PM
Subject: Adult Post Splenectomy vaccines - review

The Post Splenectomy vaccine order set was updated several months ago. I wanted to refresh/introduce some of the changes with the new protocol.

    * Two different meningococcal vaccine are now recommended: MENACTRA and BEXSERO. If patient is allergic to latex, TRUMENBA can be given.
    * MENOMUNE was removed (not recommended for repeat dosing).
    * Repeat doses of MENACTRA and BEXSERO are recommended in 8 weeks.

Some general questions often asked:

1. When is best time to give the vaccines?

Ideal time is 14 days BEFORE the spleen is removed if elective case.
For emergent cases, ideal time is 14 days AFTER the spleen is removed as long as patient is not actively being treated for infection.
To help make sure patient actually receives vaccines, the order set is often prescribed to be given on day of discharge (discharge is generally around 3-7 days post spleen removal).

2. How to enter vaccines that are prescribed as 'give on day of discharge'?

Select order set in iCare.
For each of the vaccines that are appropriate, select frequency of ONCE and check PRN box.
Add comment to iCare order: Give on day of discharge.
Enter order as "Print no label" or verify order as "Print no label."
Nurse should resupply these medications on the day of discharge and pharmacy should then dispense.

Once the patient is discharged , some will come back in 8 weeks to Outpatient Medical and receive MENACTRA and BEXSERO with PNEUMOVAX if needed.

If you have questions concerning vaccines in splenectomy patients, please don't hesitate to ask. Thanks.


Jerry Robinson, Pharm.D., BCPS
Clinical Specialist STICU/Co-Chairperson, Medication Safety Committee Department of Pharmacy Huntsville Hospital