Abstract :
ISSUE: Centers for Medicare and Medicaid Services (CMS) Core Measure for Pneumonia Indicator requires that patients age 65 and older be screened for pneumococcal vaccine and be vaccinated prior to discharge if indicated. Our medical centerʹs data for quarter 1 of 2004 was 2%, 5% for quarter 2, and 48% for quarter 3. New Hampshire Senate Bill 438 (effective January 1, 2005) requires all hospitals to document evidence of immunization against pneumococcal disease for consenting patients 65 and older. Residential facilities, adult day care facilities, and assisted-living facilities shall vaccinate consenting adults within 60 days of admission to their facility. Barriers for screening process include: 1) Inaccurate information (patients do remember vaccination status). 2) Communication regarding vaccination status from ambulatory care, to acute care, to residential, assisted-living and adult day care is poor. 3) Each hospital re-admission required re-screening because tools were not in place for vaccination status to “cross over.” This resulted in inaccurate documentation and revaccination (waste of time and money). 4) Nurses fear harming the patient if re-vaccinated. 5) Nurses did not buy into vaccination program because they believed that vaccination should take place in ambulatory setting where patients can talk to their healthcare providers. 6) When patients are screened and desire vaccination, vaccination was often omitted prior to discharge.
PROCESS IMPROVEMENT: 1) Worked with local ambulatory care center (which has an electronic medical record) to provide vaccination status to local residential, assisted-living, and adult day care centers. 2) Provided local community hospital (177 beds) with a report of all patients age 65 or over who have been vaccinated. Worked with hospital information services department to develop a method that documents pneumococcal vaccine. Pneumococcal vaccine now crosses over to each admission. 3) Developed method to update both acute and ambulatory care medical records when patients are vaccinated at the hospital prior to discharge. 4) Implemented a colored sticker applied to medication administration record by pharmacy to increase vaccination compliance when desired by patient.
RESULTS: During quarter 4 2004, 91% of patients age 65 and older were screened for the pneumococcal vaccine.
