PURPOSE: Pneumococcal vaccination has been reported to improve morbidity and mortality and has been selected as a national “Core Measure” of quality. High rates of vaccination have eluded many health care systems. We report the results of sequential interventions supported by strong evidence, including (1) point of care reminders, (2) rounding pharmacists, and (3) standing orders.
METHODS: From January of 2004 to December of 2005, 896 pneumonia inpatient candidates for pneumococcal vaccination were tracked. Baseline voluntary vaccination rates from the first quarter of 2004 were recorded and for each subsequent quarter. During the first quarter of 2004, electronic point of care reminders were developed. During second and third quarters of 2004, pharmacists rounded with physicians. In December, 2004, the medical center approved a standing order for pneumococcal vaccination of all inpatients above age 65 with selected exclusions. Unless contramanded by the physician, patients who were not previously vaccinated received vaccination on hospital day 3.
RESULTS: At baseline, from January through March, 2004, 27.5% of eligible patients (27/98) received pneumococcal vaccination (JCAHO statewide average =22%). With implementation of point of care electronic reminders, second quarter rates rose to 37.4% (37/91). In June of 2004, with pharmacist rounding, total vaccination rates rose transiently to 54.8% (17/31). However, the rate for the last two quarters of 2004 was only 44.4% (91/205). Vaccination rates were 47.3% for faculty cases and 32.2% for voluntary staff cases. With implementation of standing orders, compliance rose to 84.8% (123/145) for the first quarter of 2005 and sustained a rate of 88.6% for the final two quarters of of 2005 (194/219). The state averaged 45% for 2005.
CONCLUSION: High pneumococcal vaccination rates can be achieved through standing orders and point of care reminders. While electronic reminders, pharmacist-based interventions, and faculty rounds may potentially improve compliance rates, the necessary factor for success was a standing order.
CLINICAL IMPLICATIONS: This study reports the combination of time-saving clinical and electronic interventions that lead to 89% compliance with vaccination standards for pneumococcus.
DISCLOSURE: Dani Hackner, No Financial Disclosure Information; No Product/Research Disclosure Information