Purpose Community-acquired pneumonia (CAP) due to Streptococcus pneumoniae continues to represent a major public health problem. Despite the availability of a safe and effective vaccine, it is underutilized by the medical community. Given that up to two thirds of patients with serious pneumococcal disease have been hospitalized within 4 years of their illness, the acute care hospital stay represents an opportunity for vaccination. Although The Center for Medicaid and Medicare Services (CMS) requires public reporting of pneumococcal vaccination rates for patients admitted with pneumonia, few data exist as to how hospital personnel can improve their performance in achieving adequate rates of vaccination. We report our experience of a stepwise program to improve vaccination rates in hospitalized patients with CAP.
Methods The Medical University of South Carolina Medical Center used chart review to assess vaccination status on all patients admitted with a primary diagnosis of CAP. The education portion of the program, consisting of barrier determination and literature reviews, was initiated at the physician and nurse level in July 2001. In September 2001, a nursing assessment form was initiated with subsequent quarterly feedback to nurses and physicians regarding vaccination rates. In January 2003, a standing order form was initiated. Administrative leadership support was provided throughout the program.
Summary Vaccination rates improved steadily each quarter after the initiation of the program. Baseline vaccination rates were only 4% for patients admitted with CAP. After the initiation of education strategies in July 2001, vaccination rates increased to 33% by 3rd quarter 2001. After the initiation of the nurse assessment form in September 2001, vaccination rates increased to 71% by 4th quarter 2002. After the initiation of the standing order program in January 2003, vaccination rates increased to 95% by 1st quarter 2004. Second quarter preliminary rates have remained > 95% (preliminary data 100%).
Conclusions Our medical center used a multistep approach to attain vaccination rates in compliance with federal guidelines. We first initiated physician and nursing education strategies, then added a nursing assessment form in the medical records. This was followed by data feedback at the physician and nurse levels, and finally by the institution of a standing orders program. We found remarkable success with this multistep program and recommend it to other medical centers.
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