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Overcoming barriers to establishing an inpatient vaccination program for pneumococcus using standing orders
Donald B Middleton1, Dwight E Fox, Mary Patricia Nowalk
1Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15215, USA. middletondb@upmc.edu
Infection Control and Hospital Epidemiology
|December 3, 2005
Summary
Implementing standing orders programs (SOPs) for adult pneumococcal vaccination in hospitals improves vaccination rates. Identifying and addressing patient, provider, and institutional barriers is key to successful program rollout.
Area of Science:
- Healthcare Management
- Vaccinology
- Public Health
Background:
- Inpatient vaccination rates for pneumococcal polysaccharide vaccine (PPSV23) are often suboptimal.
- Hospitals with standing orders programs (SOPs) generally achieve higher vaccination rates compared to those relying solely on individual physician orders.
- Implementing SOPs can streamline vaccination processes for eligible adult inpatients.
Purpose of the Study:
- To identify and classify barriers encountered during the establishment of an adult pneumococcal vaccination SOP in acute care settings.
- To provide actionable recommendations for overcoming identified implementation barriers.
- To facilitate the successful transition and sustained implementation of inpatient pneumococcal vaccination SOPs.
Main Methods:
- A descriptive study was conducted analyzing barriers and solutions during SOP implementation across three hospitals within the University of Pittsburgh Medical Center Health System.
- A comprehensive review of scientific literature pertaining to inpatient vaccination SOPs was also performed.
- The study involved hospitals with established physician order-driven vaccination programs that incorporated SOPs for pneumococcal vaccination.
Main Results:
- Barriers to SOP implementation were identified across all stages and categorized into patient-related, provider-related, and institutional factors.
- Continual review and program revision in response to encountered barriers led to the development of strategies to overcome these impediments.
- Specific barriers and corresponding solutions were documented to guide future implementation efforts.
Conclusions:
- Successful implementation of an adult pneumococcal vaccination SOP requires strong administrative commitment, including physician leadership and ongoing staff education and training.
- Close monitoring of vaccination rates and leveraging external motivators like legal statutes and hospital rating evaluations are crucial for program success.
- Addressing identified barriers proactively allows for a smoother transition to and sustained effectiveness of inpatient vaccination SOPs.