Increasing pneumococcal vaccination rates among hospitalized patients.
OBJECTIVE
To increase the proportion of inpatients vaccinated against pneumococcal infection.


METHODS
Pre- and post-intervention study.


METHODS
University medical center-affiliated, suburban community teaching hospital.


METHODS
Unvaccinated inpatients 65 years and older and those 2 to 64 years old who had chronic medical conditions predisposing them to invasive pneumococcal infection.


METHODS
The nursing staff screened newly admitted patients for eligibility based on age, diagnosis, or medications from a computer-generated admissions list and placed a pre-printed order form for the pneumococcal polysaccharide vaccine (PPV) on the charts of eligible patients. Following the physician's order, the nursing staff administered the PPV and recorded it Ongoing quality improvements including admission vaccination screening and computer-based record keeping were initiated to identify unvaccinated eligible patients and track vaccination status.


RESULTS
Efforts resulted in rates of in-hospital vaccination ranging from 3.1% to 7.9% (mean, 5.2% +/- 1.7% [standard deviation]) and significant improvements in the assessment of previous vaccination status, reaching 54% of eligible patients after 1 year. Ascertainment of a previous vaccination increased significantly following the initiation of the use of admission forms that specifically assessed vaccination status and a system to permanently record vaccination status in an electronic medical record (P < .05).


CONCLUSIONS
Concerted efforts using electronic medical records significantly improved the assessment and documentation of inpatient vaccination status. Greater improvement of the rates of in-hospital vaccination will require healthcare system-wide efforts such as a standing order policy for vaccinating all eligible patients. Standing orders for inpatient immunization supported by effective assessment and tracking systems have the potential to raise vaccination rates to the goals of Healthy People 2010.
Nowalk
Mary Patricia
MP
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, PA 15261, USA.
Middleton
Donald B
DB
Zimmerman
Richard K
RK
Hess
Mary M
MM
Skledar
Susan J
SJ
Jacobs
Marjorie A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006744:Hospital Bed Capacity, 100 to 299; D006784:Hospitals, Teaching; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D014611:Vaccination / Q000706:statistics & numerical data*
D022242:Pneumococcal Vaccines