Improving Influenza/Pneumococcal Immunization in Hospitalized Patients

BACKGROUND: Annually, 20,000 deaths from influenza and 40,000 from pneumococcus occur in the United States. Vaccination against both can prevent associated morbidity and mortality but are underutilized. To improve vaccination rates, a standing order protocol (SOP) for hospitalized patients was initiated. METHODS: A multidisciplinary team designed the SOP form. Medical Board approval was obtained to ensure physician acceptance. Promotion of the program was done. On admission, registered nurses complete the SOP form for each patient and have authority to immunize without a physician order. The patient must be high risk for influenza or pneumococcus complications based on established criteria and must agree to be vaccinated. A patient is not immunized if they have contraindications or refuse, or if the physician writes an order not to immunize. RESULTS: SOP form analysis since 2001 shows that assessment of patients for the vaccines has increased dramatically. Nearly 2000 patients were assessed this fall. Influenza vaccinations increased by 17%. Of those not vaccinated, 29% had already received the vaccine, 46% refused, and 7% had physician orders not to vaccinate. Pneumococcal vaccination increased by 19%. Of those not vaccinated, 14% had already received the vaccine, 61% refused, and 4% had physician orders not to vaccinate. CONCLUSIONS: The SOP form is a useful quality-improvement tool for risk assessment and for improving vaccination rates. The number of immunizations given to hospitalized patients has increased with the use of standing orders. However, barriers to vaccination remain, including understanding by staff and the public for the need and benefits of these vaccinations.