Article

Improving the Rates of Inpatient Pneumococcal Vaccination: Impact of Standing Orders Versus Computerized Reminders to Physicians •

Division of Infectious Diseases, Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.
Infection Control and Hospital Epidemiology (Impact Factor: 3.94). 11/2004; 25(11):904-7. DOI: 10.1086/502317
Source: PubMed

ABSTRACT To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group.
Open trial of the following approaches, each on a different ward: (1) standing orders for vaccination of eligible consenting patients, (2) computerized reminders to physicians, and (3) usual practice.
Four hundred twenty-four patients were admitted to three 30-bed inpatient medical wards during a 4-month period in 1999 at one hospital. Unvaccinated patients 65 years or older and competent to give oral consent were included.
A pharmacist activated a standing orders protocol for vaccination of all eligible consenting patients on one ward and computerized reminders to physicians on a second ward. A third ward served as a control group.
Forty-two patients met inclusion criteria and accepted vaccination in the standing orders arm versus 35 patients in the computerized reminder arm. Vaccination rates on the standing orders ward included 98% of those eligible and accepting vaccination, 73% of eligible patients, and 28% of all patients admitted. Rates on the computerized reminder ward were 23%, 15%, and 7%, respectively. All of the rates from the standing orders ward were significantly greater than those from the computerized reminder ward (P < .0001). Only 0.6% of all patients on the control arm were vaccinated.
Although both interventions were effective in increasing inpatient pneumococcal vaccination rates relative to baseline practice, physician independent initiation of standing orders was clearly more effective.

Download full-text

Full-text

Available from: Brian Currie, Jul 30, 2014
0 Followers
 · 
135 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Industrial processing today shows a trend toward increasing complexity and automtion. This often implies for the human operator a role mainly as supervisor over a large set of monitoring instruments. A fundamental difficulty arises in emergency situations: the amount of information that the monitoring instruments may present to the operator can be overwhelming. There may be hundreds of plant variables competing for the operator's attention. As a result, the performance of the human operator can become degraded in emergency situations. Automatic prioritization of the information is needd to assist the operator. This paper discusses sophisticated approaches for accomplishing such prioritization.
  • Infection Control and Hospital Epidemiology 12/2004; 25(11):901-3. DOI:10.1086/502316 · 3.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Adolescent immunization is a growing field, with many new vaccines in development and new or expanded immunization recommendations on the horizon. Characteristics of adolescents and their health care are discussed, focusing specifically on the challenges of incorporating a potential recommendation to replace tetanus-diphtheria toxoid with tetanus-diphtheria-acellular pertussis vaccine during early or middle adolescence as part of routine preventive care. Using the framework created by the Centers for Disease Control and Prevention's Task Force on Community Preventive Services, three overlapping levels at which there are opportunities for vaccine intervention are reviewed: (1) health care systems (enhancing access to vaccination services); (2) health care providers (provider-based interventions); and (3) patients and families ("increasing community demand"). There are several barriers to vaccine implementation that make achieving high immunization coverage rates among adolescents a challenge. Promising interventions for improving vaccination rates at the health care system level include reducing out-of-pocket costs, expanding access to immunizations, and implementing vaccination programs in schools. Provider-based interventions for improving vaccination rates include regular assessments of immunization rate with feedback to all office personnel, provider reminders, and standing orders. Client recall and reminders, education, and requirements for school entry can assist in "increasing community demand" for vaccinations in that they motivate parents and adolescents to follow through with immunizations. Adolescents are unique from other populations. Previously studied interventions need to be tested in this age group as immunization becomes a more salient issue in adolescent health care.
    The Pediatric Infectious Disease Journal 07/2005; 24(6 Suppl):S134-40. · 3.14 Impact Factor
Show more