Improving Rates for Pneumococcal and Influenza Vaccines

Abstract

ISSUE: This is a 60-bed community hospital with approximately 13.4% of inpatient admissions being = > 65 years old. Chart review revealed under-use of the pneumococcal and influenza vaccine in the over 65 patient population. Over the years, administration of these vaccines has been left to the discretion of the primary care physician. The numbers reported in the chart review were consistent with numbers reported for vaccine use in the literature for the eligible patients. In October 2002, the Centers for Medicare and Medicaid had published a final rule permitting the use of standing orders for these vaccines, allowing their administration without a physician's signature. This project was done to increase pneumoccal and influenza vaccine rate among eligible patients in this hospital. PROJECT: In lieu of a standing order, in 2003 the Case managers were asked to assess patients and put a reminder in the progress notes of eligible patients' charts to remind physicians to order the vaccines. This method met with little success. In 2004 we started a workgroup involving case management, nursing, pharmacy, quality improvement and infection control. The workgroup was to develop and implement a standing order protocol. The workgroup wrote a policy, developed forms for assessment and reminder stickers, prepared a self-study packet and conducted a house-wide education for nurses, pharmacy and physicians. The case managers were assigned the task of assessing the patients and implementing the standing order protocol. RESULTS: Vaccination rates improved greatly. Influenza vaccinations went from being administered to 50% of eligible patients in 2003 to 84% of eligible patients in 2005 and subsequently a rise was seen in the pneumococcal rates, which went from 50% of eligible patients in 2003 to 85% of eligible patients in 2005. Vaccine failure rates were mainly seen for patients admitted on weekends or holidays and dismissed without case management involvement. LESSONS LEARNED: Standing order is important in improving vaccination rates however without proper implementation it is relatively ineffective. Thus, creating a protocol for proper implementation of the order becomes even more important. Cues and reminders proved to be very important. Incremental implementation helped with physician buy-in for full implementation. Improvement is still needed in creating and implementing a weekend protocol for eligible patients who are dismissed before being seen by case managers. ISSUE: This is a 60-bed community hospital with approximately 13.4% of inpatient admissions being = > 65 years old. Chart review revealed under-use of the pneumococcal and influenza vaccine in the over 65 patient population. Over the years, administration of these vaccines has been left to the discretion of the primary care physician. The numbers reported in the chart review were consistent with numbers reported for vaccine use in the literature for the eligible patients. In October 2002, the Centers for Medicare and Medicaid had published a final rule permitting the use of standing orders for these vaccines, allowing their administration without a physician's signature. This project was done to increase pneumoccal and influenza vaccine rate among eligible patients in this hospital. PROJECT: In lieu of a standing order, in 2003 the Case managers were asked to assess patients and put a reminder in the progress notes of eligible patients' charts to remind physicians to order the vaccines. This method met with little success. In 2004 we started a workgroup involving case management, nursing, pharmacy, quality improvement and infection control. The workgroup was to develop and implement a standing order protocol. The workgroup wrote a policy, developed forms for assessment and reminder stickers, prepared a self-study packet and conducted a house-wide education for nurses, pharmacy and physicians. The case managers were assigned the task of assessing the patients and implementing the standing order protocol. RESULTS: Vaccination rates improved greatly. Influenza vaccinations went from being administered to 50% of eligible patients in 2003 to 84% of eligible patients in 2005 and subsequently a rise was seen in the pneumococcal rates, which went from 50% of eligible patients in 2003 to 85% of eligible patients in 2005. Vaccine failure rates were mainly seen for patients admitted on weekends or holidays and dismissed without case management involvement. LESSONS LEARNED: Standing order is important in improving vaccination rates however without proper implementation it is relatively ineffective. Thus, creating a protocol for proper implementation of the order becomes even more important. Cues and reminders proved to be very important. Incremental implementation helped with physician buy-in for full implementation. Improvement is still needed in creating and implementing a weekend protocol for eligible patients who are dismissed before being seen by case managers.