Lessons learned from inpatient vaccination in Michigan

This study was a retrospective, preintervention and postintervention evaluation of influenza and pneumococcal vaccination among hospitalized patients eligible for vaccination. The authors abstracted 1476 randomly sampled patient charts to compare vaccination before (2002) or after (2003) implementation of vaccination policies in 4 Michigan hospitals. In addition, they assessed completeness of vaccine assessment forms, evaluated reasons for nonvaccination, and conducted interviews with hospital staff. Vaccination increased at 3 of 4 hospitals after implementation of vaccination policies, yet rates remained low (<10% overall; range, 3.4%-12.4%). Vaccine assessment forms were found in most of the charts in 2003, but almost a third were incomplete. Challenges to implementing inpatient vaccination included support and training of hospital staff, interpretation of vaccination recommendations, lack of systematic prompts for vaccinations, and cost reimbursement. These findings underscore the need for continuous quality improvement and process monitoring to determine strategies for overcoming challenges to inpatient vaccination.