title: A review of acute care interventions to improve inpatient pneumococcal vaccination.
abstract: OBJECTIVE
  To provide a narrative review of the impact of provider-based, organizational strategies in acute care settings to improve pneumococcal vaccination rates among patients over 65, and 2-64 years with high risk medical conditions.
  
  
  METHODS
  A search was conducted using MEDLINE, Scopus, CINAHL and Web of Science databases for hospital-based, inpatient studies which evaluated strategies to improve pneumococcal vaccination rates. Studies published in English from 1983 to 2013 were included. Data abstracted was analyzed descriptively.
  
  
  RESULTS
  A total of 35 studies were included; 15 evaluated physician reminders (e.g. chart or paper reminders, pre-printed orders (PPOs), computerized reminders, checklists) and 21 standing orders programs (SOPs). The most common study design was pre/post, and only 7 studies had a control group. Overall, 32 studies showed improvements in the rate of pneumococcal vaccination following intervention (19 statistically significant), with reminders showing 29-74% immunization rate, PPCO 5-42%, and SOPs 3.4-78%.
  
  
  CONCLUSIONS
  Hospital-based interventions improve pneumococcal vaccination in older adults and younger individuals at risk. Although this review found that more success was observed with SOPs the impact on immunization rates in eligible patients varied significantly. Thus, high quality, randomized-controlled studies are required to determine the effect of each type of institutional immunization strategy.
authors.affiliation: Faculty of Pharmacy & Pharmaceutical Sciences, 3-229 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave.,, Edmonton, Alberta T6G 1C9, Canada.
authors.forename: Sujin
authors.initials: S
authors.lastname: Kim
authors.affiliation: Faculty of Pharmacy & Pharmaceutical Sciences, 3-229 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave.,, Edmonton, Alberta T6G 1C9, Canada.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Hughes
authors.affiliation: Faculty of Pharmacy & Pharmaceutical Sciences, 3-229 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave.,, Edmonton, Alberta T6G 1C9, Canada. Electronic address: cherylas@ualberta.ca.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Sadowski
mesh_terms: D006739:Hospital Administration; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D014611:Vaccination
chemical_list: D022242:Pneumococcal Vaccines
keywords: Aged; Geriatric; Hospital; Infection; Inpatient; Pneumococcal; Vaccination