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Increasing Pneumococcal Vaccination Rates Among Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015

Mary Patricia Nowalk ,
Donald B. Middleton ,
Richard K. Zimmerman ,
Mary M. Hess ,
Susan J. Skledar  and
Marjorie A. Jacobs
Mary Patricia Nowalk*
Affiliation:
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, St. Margaret Hospital, Pittsburgh, Pennsylvania
Donald B. Middleton
Affiliation:
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, St. Margaret Hospital, Pittsburgh, Pennsylvania University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pennsylvania
Richard K. Zimmerman
Affiliation:
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, St. Margaret Hospital, Pittsburgh, Pennsylvania
Mary M. Hess
Affiliation:
University of Pittsburgh School of Pharmacy and the University of Pittsburgh Medical Center, Drug Use and Disease State Management Program, St. Margaret Hospital, Pittsburgh, Pennsylvania Greenville Health System, Greenville, South Carolina
Susan J. Skledar
Affiliation:
University of Pittsburgh School of Pharmacy and the University of Pittsburgh Medical Center, Drug Use and Disease State Management Program, St. Margaret Hospital, Pittsburgh, Pennsylvania
Marjorie A. Jacobs
Affiliation:
University of Pittsburgh Medical Center, St. Margaret Hospital, Pittsburgh, Pennsylvania
*
Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh, 3518 Fifth Avenue, Pittsburgh, PA 15261
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Abstract

Objective:

To increase the proportion of inpatients vaccinated against pneumococcal infection.

Design:

Pre- and post-intervention study.

Setting:

University medical center–affiliated, suburban community teaching hospital.

Patients:

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

Intervention:

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).

Conclusion:

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 (Infect Control Hosp Epidemiol 2003;24:526-531)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 7 , July 2003 , pp. 526 - 531
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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