Implementation and evaluation of a nursing assessment/standing orders–based inpatient pneumococcal vaccination program

Eckrode, C.A.; Church, Nancy J.; English, Woodruff J.

doi:10.1016/j.ajic.2006.08.005

Cited by 16 publications

(8 citation statements)

References 32 publications

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“…Many initiatives to improve quality measures focus on nurse or pharmacist interventions and remove the clinician from the decision-making process. 12,13 Our approach ensures that housestaff remain integral team members for quality care. Thus, the electronic checklist supports our institutional goal to improve care and simultaneously educate and prepare residents for practice in the rapidly evolving pay-forperformance health care system.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

et al. 2009

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Many of the quality measures for patients with heart failure (HF) or acute myocardial infarction (AMI) require the completion of comprehensive discharge instructions, including instructions about medications to be taken after discharge. To improve compliance in a tertiary care teaching hospital with these evidence-based quality measures, a clinical-decision-support system (CDSS) that uses an electronic checklist was developed. The CDSS prompts clinicians at every training level to consistently create comprehensive discharge instructions addressing quality measures. The authors compared compliance during the 15-month preintervention and postintervention periods. Compliance with discharge measures for AMI (i.e., aspirin, beta-blocker, angiotensin-converting enzyme inhibitor [ACEI], or angiotensin receptor blocker [ARB] use) and for HF (i.e., discharge instructions, left ventricular systolic function [LVSF] evaluation, and ACEI/ARB use) was assessed. The delivery of discharge instructions showed significant improvement from the preintervention period to the postintervention period (37.2% to 93.0%; P < .001). Compliance with prescription of ACEI or ARB also improved significantly for HF (80.7% to 96.4%; P < .001) and AMI (88.1% to 100%; P = .014) patients. Compliance with the remaining measures was higher before intervention, and, thus, the modest improvement in the postintervention period was not statistically significant (AMI patients: aspirin, 97.5% to 98.8%; P = .43; and beta-blocker, 97.9% to 98.7%; P = .78; HF patients: LVSF, 99.3% to 99.1%; P = .78). Implementation of a CDSS with computerized electronic prompts improved compliance with selected cardiac-care quality measures. The design of quality-improvement decision-support tools should incorporate educational missions in their message and design.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

et al. 2009

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“…Compared with other health care systems with a standing orders protocol in place, Montefiore Medical Center is among the most unique. 10–12 With the pharmacist screening potential candidates for vaccination directly on the care units and providing education directly at the patient's bedside, the institution has developed a successful clinical pharmacy vaccination practice. Because a deficit in knowledge was one of the primary causes of low vaccination rates prior to the STOP program, educational sessions tailored to physicians, nurses, and pharmacists are conducted by the STOP pharmacist.…”

Section: Discussionmentioning

confidence: 99%

The STanding Orders Protocol (STOP): A Pharmacy Driven Pneumococcal and Influenza Vaccination Program

2009

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Purpose A Medical Board-approved pharmacy-based inpatient STanding Orders Protocol (STOP) for influenza and pneumococcal vaccination was designed and implemented at Montefiore Medical Center in response to federal and state regulations put in place in 2006. This vaccination program aims to improve historically poor vaccination rates in a complex, urban patient population. Developing this initiative in a large health care system with high turnover and a diverse (many non-English speaking) population represented a formidable challenge. Methods In 2006 the institution initiated a program to improve patient care. The program involved a clinical pharmacist rounding on patient care units specifically to encourage the acceptance of the pneumococcal and influenza vaccine in patients at least 65 years of age at 1 of the 2 campus sites in the Bronx, New York. Medical residents were also employed to facilitate the pharmacist and achieve national standards. Registered nurses and licensed practical nurses are authorized to administer standing orders for vaccines and anaphylaxis treatment agents as needed under this protocol without direct physician examination. Vaccine information sheets (VIS) and gender- and ethnicity-specific patient teaching aids provide statistical information regarding disease and mortality rates. Language barriers are reduced by providing VIS in both Spanish and English, and telephone translation in most languages are utilized when necessary. Documentation of refusal of, previously received, or a newly ordered vaccination is placed in the patient's chart and in the central database. Discussion Prior to the STOP program, the total in-hospital vaccination encounter rates according to various Center for Medicare and Medicaid Services (CMS) audits was approximately 18% for pneumococcal and 27% for influenza vaccinations, respectively. The institution's current encounter rates have dramatically increased to more than 85% for pneumococcal and 55% for influenza vaccine. Conclusion The cooperative efforts of physicians, pharmacists, and nursing staff have led to the creation of a successful inpatient-based vaccine standing orders protocol. As a result, in 2007 the institution approved a second clinical pharmacist to allow for coverage at both of Montefiore's hospital sites. The hospital's goal is to ultimately decrease pneumococcal disease and its severity, increase and maintain the highest vaccination rates in New York City, and comply with national standards. The implication for decreasing morbidity and readmission of patients is promising. Future plans include the development of an ambulatory-based program with a similar design model.

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“…39 In addition to the influenza vaccine, 2 studies were focused on pneumococcal polysaccharide vaccination in special populations. 40,41 In 1 study, nursing-driven assessments and standing orders were used to increase vaccination in children who were hospitalized with risk factors as well as in adults who were hospitalized at their institution; in the second study, staff education and EMR order sets were used for patients with diabetes mellitus, and both led to increased inpatient immunization rates by 15% and 43%, respectively. 40,41 Through these studies, lessons were learned that may better inform further interventions.…”

Section: Inpatient Interventionsmentioning

confidence: 99%

“…40,41 In 1 study, nursing-driven assessments and standing orders were used to increase vaccination in children who were hospitalized with risk factors as well as in adults who were hospitalized at their institution; in the second study, staff education and EMR order sets were used for patients with diabetes mellitus, and both led to increased inpatient immunization rates by 15% and 43%, respectively. 40,41 Through these studies, lessons were learned that may better inform further interventions. Increased involvement and empowerment of the nursing staff was frequently cited in successful programs, and multiple studies relied on a nurse coordinator or on nursing-driven protocols to improve vaccine uptake.…”

Section: Inpatient Interventionsmentioning

confidence: 99%

“…Increased involvement and empowerment of the nursing staff was frequently cited in successful programs, and multiple studies relied on a nurse coordinator or on nursing-driven protocols to improve vaccine uptake. 12,13,15,38,40 Further strategies for improvement included the development of clinical guidelines, standardized screening forms, online staff resources, EMR prompts, education, and adding underimmunization to a hospitalized patient' s acute problem list. 12,18,22,42,43 These mirror approaches already identified in the adult literature, including nursing-driven vaccination screening, standing orders, immunization histories taken by pharmacists, clinical pathways, chart reminders, and patient education.…”

Section: Inpatient Interventionsmentioning

confidence: 99%

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Pediatric Inpatient Immunizations: A Literature Review

Mihalek

Kysh

Pannaraj

2019

Hospital Pediatrics

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Timely vaccine uptake in children remains suboptimal. Eliminating missed opportunities is key to increasing childhood immunization rates, and hospitalization offers another potential setting to vaccinate. OBJECTIVE:To better understand pediatric inpatient immunization programs, including vaccination rates of inpatients, parental and provider attitudes, barriers to vaccine delivery, and interventions to increase provision of inpatient vaccines. DATA SOURCES: A search was conducted of PubMed, Embase, and Web of Science to identify articles and conference abstracts related to pediatric inpatient immunization.STUDY SELECTION: Inclusion criteria were studies published in English between January 1990 and January 2019 in which pediatric vaccination in the hospital setting was discussed. Findings from 30 articles and conference abstracts were summarized and organized by topic area.DATA EXTRACTION: Abstracts were screened for relevance, articles were read, and themes were identified. RESULTS:Children who are hospitalized have been shown to have lower immunization rates compared with the general population, with 27% to 84% of pediatric inpatients due or overdue for vaccines nationally when verified with official records. Unfortunately, little is done to catch up these children once they have been identified. Access to accurate vaccine histories remains a major barrier in inpatient immunization programs because providers frequently under document and parents over recall a child's vaccine status. Strategies identified to increase inpatient vaccination included creation of a multidisciplinary immunization team, educational interventions, visual reminders, catch-up vaccine plans, order sets, and nursing-driven screening. When offered inpatient vaccination, a majority of parents accepted immunizations for their children. CONCLUSIONS:Hospitalization may provide an opportunity to augment vaccine uptake. Further research is needed to develop evidence-based strategies to overcome barriers to inpatient vaccination.

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Implementation and evaluation of a nursing assessment/standing orders–based inpatient pneumococcal vaccination program

Cited by 16 publications

References 32 publications

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

Effectiveness of a Clinical-Decision-Support System in Improving Compliance With Cardiac-Care Quality Measures and Supporting Resident Training

The STanding Orders Protocol (STOP): A Pharmacy Driven Pneumococcal and Influenza Vaccination Program

Pediatric Inpatient Immunizations: A Literature Review

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