title: Overcoming barriers to establishing an inpatient vaccination program for pneumococcus using standing orders.
abstract: OBJECTIVE
  To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.
  
  
  METHODS
  Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature.
  
  
  METHODS
  As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine.
  
  
  RESULTS
  Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments.
  
  
  CONCLUSIONS
  A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.
authors.affiliation: Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15215, USA. middletondb@upmc.edu
authors.forename: Donald B
authors.initials: DB
authors.lastname: Middleton
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Fox
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Skledar
authors.forename: Denise R
authors.initials: DR
authors.lastname: Sokos
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Ervin
authors.forename: Chyongchiou J
authors.initials: CJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D019091:Critical Pathways; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs / Q000592:standards*; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines