Hospital-based strategies for improving influenza vaccination rates

Patients at highest risk for complications from influenza have the lowest rates of vaccination. Each year there are thousands of deaths related to influenza. Many of those who are hospitalized or who die from influenza-related conditions were hospitalized during the preceding influenza vaccination season but not vaccinated.

Six community hospitals in northern Minnesota participated in a pilot project to assess the feasibility and effectiveness of three different community hospital-based influenza vaccination programs during the 1991-1992 immunization season. Records of patients discharged from each institution during November and December 1991 were reviewed for documentation of indications for influenza immunization and to determine whether vaccination was offered and whether vaccination occurred before discharge.

In hospitals choosing to implement standing orders for their nursing staffs to review indications for influenza vaccination and administer if indicated, 95.2% of patients were offered vaccination. In hospitals depending on physician chart reminders, 22% of patients were offered vaccination. In hospitals relying on physician education strategies to promote influenza vaccine, only 11.7% of patients were offered vaccination. Documented immunization rates in these three groups were 40.3%, 17%, and 9.6%, respectively.

Programs implementing standing orders for nursing staffs were more effective than educational programs or physician reminders in offering and administering influenza vaccine to hospitalized patients. Hospital policies can expand the number of high-risk and elderly persons who receive influenza vaccination each year, but hospitals need to be reimbursed for this service to ensure institutional support.