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Implementation and evaluation of a nursing assessment/standing orders-based inpatient pneumococcal vaccination
Carl Eckrode1, Nancy Church, Woodruff J English
1Respiratory Care Program, Mt. Hood Community College, Gresham, Oregon 97222, USA.
American Journal of Infection Control
|October 16, 2007
Summary
An inpatient pneumococcal vaccination program using standing orders and nurse assessment significantly increased vaccination opportunities and rates in patients aged 2 and older. This method proved more effective than physician-ordered vaccinations for improving pneumococcal immunization coverage.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Pneumococcal vaccination is recommended for individuals 65 years and older.
- Inpatient vaccination strategies are explored to enhance immunization rates in eligible populations.
- This study expanded the focus to include at-risk patients aged 2-64 years.
Purpose of the Study:
- To evaluate the effectiveness of an inpatient pneumococcal vaccination program.
- To compare a standing orders-based program with nurse assessment against a physician-ordered vaccination method.
- To determine if the program could significantly increase pneumococcal vaccination opportunities and rates.
Main Methods:
- Retrospective evaluation of medical records for inpatients (August-December 2004).
- Inclusion criteria: patients aged >65 years or aged 2-64 years with risk factors for pneumococcal bacteremia.
- Exclusion criteria: recent vaccination, terminal care, allergies, recent transplants, physician contraindications.
Main Results:
- The standing orders-based program increased the vaccination opportunity rate from 8.6% to 59.1%.
- Overall vaccination rates improved from 0% to 15.4% with the new program.
- Statistically significant improvements in both vaccination opportunities (p=.00) and rates (p=.00) were observed.
Conclusions:
- The inpatient vaccination program significantly enhanced vaccination opportunities and rates compared to the previous physician-based method.
- Achieved vaccination rates were lower than some literature reports, potentially due to high patient refusal rates.
- Standing orders and nurse-led assessment represent an effective strategy for increasing inpatient pneumococcal vaccination.
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