title: Overcoming barriers to pneumococcal vaccination in patients with pneumonia.
abstract: Inpatient pneumococcal vaccination remains underutilized, and little data exist to guide hospital personnel in improving their performance. The authors report their experience with a stepwise program to improve vaccination assessment rates for hospitalized patients with community-acquired pneumonia. They assessed barriers to vaccination and applied a stepwise educational and intranet-based decision support implementation program for hospitalized patients with community-acquired pneumonia. Preintervention vaccination rates were 0%. Primary nursing and physician barriers were assessed. An educational intervention increased vaccination assessment rates to 35%, a nursing decision-support tool to 42%, and approval of a standing order policy to 96%. For patients older than 65 years, vaccination assessment rates increased 33%, 67%, and 100%, respectively. An educational program combined with a decision support tool and a standing order policy can improve vaccination assessment rates to high levels. This study suggests that a multidimensional intervention is required to improve compliance with inpatient vaccination best clinical practices.
authors.affiliation: Brigham and Women's Hospital in Boston, Massachusetts, Department of Medicine and Hospitalist Medicine, 75 Francis Street, PB/B4/424, Boston, MA 02115, USA. scheured@musc.edu
authors.forename: Danielle B
authors.initials: DB
authors.lastname: Scheurer
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cawley
authors.forename: Shirley B
authors.initials: SB
authors.lastname: Brown
authors.forename: John E
authors.initials: JE
authors.lastname: Heffner
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections; D020000:Decision Support Systems, Clinical; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007297:Inpatients; D010353:Patient Education as Topic; D011008:Pneumococcal Infections / Q000276:immunology*; D013022:South Carolina