Opportunities and obstacles: Inpatient vaccination programs a successful strategy working with hospital based clinicians and pharmacy

Abstract

BACKGROUND/OBJECTIVES: Pneumonia and influenza (flu) together are the sixth leading cause of death in the United States and represent more than 20,000 deaths per year. The national cost of hospitalization with or without mortality is probably in the billions, even in the absence of an epidemic. The Centers for Disease Control and Prevention (CDC) and local health departments have investigated clusters of pneumonia-related deaths at chronic care facilities and found that two-thirds of residents are not immunized for S. pneumoniae, a common cause of pneumonia with sepsis. During the 1998-1999 winter season (October–January), a 90-bed facility admitted 950 patients aged 65 or older, yet administered only 30 inpatient flu vaccinations. METHODS: The project involved a new record check, cue to clinicians, and promotion of an inpatient vaccination program, which involves: 1) checking several times per week in our database for vaccine status of admissions over 65 years of age, 2) a pre-printed adult immunization order sheets, stamped and placed prominently in the chart, 3) orders by hospital-based service (HBS), as well as many of the specialty groups, for vaccination, with a copy being retained in pharmacy, and 4) infection control (IC) staff making frequent pickups to ensure prompt data entry. In addition, the facility has had a community-acquired pneumonia pathway with a preprinted order set in place since 2000. This order set also cues the clinician to check if patient needs pneumovax or flu vaccine, thereby supporting the inpatient vaccine program by raising the topic immediately upon patient admission. RESULTS: During this season, as of January 20, 2005, admissions were >1400, and a total of 230 killed flu vaccine and 70 pneumovax were given to inpatients, a 700% improvement. The actual savings of our vaccinations this season is difficult to assess but may be more than $1.5 million in prevented disease. CONCLUSIONS: Obstacles still remain: audits of patient charts show that not all immunization orders result in receipt of vaccine. In a few cases, patients with record of up-to-date vaccination received an extra dose. Generally, however, progress has been made. Finally, coordination of this program requires a designated point person. Very few IC professionals have adequate resources to monitor this additional task in this very active infection control era. However, at our facility, this collaboration with clinicians, pharmacy, and patients has been a plus for our IC program.