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Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders
D C Rhew1, P A Glassman, M B Goetz
1Department of Medicine, UCLA, Los Angeles, CA, USA.
Objective:
To compare the effectiveness of three interventions designed to improve the pneumococcal vaccination rate.
Design:
A prospective controlled trial.
Setting:
Department of Veterans Affairs ambulatory care clinic.
Patients/Participants:
There were 3, 502 outpatients with scheduled visits divided into three clinic teams (A, B, or C).
Interventions:
During a 12-week period, each clinic team received one intervention: (A) nurse standing orders with comparative feedback as well as patient and clinician reminders; (B) nurse standing orders with compliance reminders as well as patient and clinician reminders; and (C) patient and clinician reminders alone. Team A nurses (comparative feedback group) received information on their vaccine rates relative to those of team B nurses. Team B nurses (compliance reminders group) received reminders to vaccinate but no information on vaccine rates.
Measurements And Main Results:
Team A nurses assessed more patients than team B nurses (39% vs 34%, p =.009). However, vaccination rates per total patient population were similar (22% vs 25%, p =.09). The vaccination rates for both team A and team B were significantly higher than the 5% vaccination rate for team C (p <.001).
Conclusions:
Nurse-initiated vaccine protocols raised vaccination rates substantially more than a physician and patient reminder system. The nurse-initiated protocol with comparative feedback modestly improved the assessment rate compared with the protocol with compliance reminders, but overall vaccination rates were similar.
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