Using medical record reminders to improve pneumococcal vaccination rates

Despite widespread recommendations, the pneumococcal vaccination rate of patients 65 years of age or older is below target goals. A reminder system was instituted at the time of the scheduled primary care visit as a pilot quality improvement project.

Medical records staff used clinic schedules to identify patients 65 years of age or older, stamping that day's progress note with a reminder about pneumococcal vaccination. The physician could note previous vaccination or could order vaccination at the visit. If the patient was previously vaccinated or received a vaccine during that visit, an indicator was placed on the front of the chart. Staff at both clinics received an educational session on the indications and benefits of pneumococcal vaccination.

Before implementing the reminder intervention, the pneumococcal immunization recording was comparable at the reminder clinic and at a second clinic that did not use reminders (x2 = 0.324, NS). At 6 months, 95/112 (85%) and 75/115 (65%) patients at the reminder and the second clinic had documentation of pneumococcal vaccination (x2 = 12.66, p < .005); at 12 months, 76% and 58% had such documentation. At the reminder clinic, the reminder stamp was found in 158/205 (77%) of the charts reviewed, with documentation of pneumococcal vaccination in 140/158 (89%) of these charts.

The simple and inexpensive method of placing selective reminders in charts for elderly patients eligible for pneumococcal vaccination was highly effective in increasing the pneumococcal vaccination rate.