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Infect Control Hosp Epidemiol. 2004 Nov;25(11):904-7.

Improving the rates of inpatient pneumococcal vaccination: impact of standing orders versus computerized reminders to physicians.

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  • 1Division of Infectious Diseases, Department of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.

Abstract

OBJECTIVE:

To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group.

DESIGN:

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.

SETTING AND PATIENTS:

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.

INTERVENTION:

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.

RESULTS:

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.

CONCLUSION:

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.

PMID:
15566021
[PubMed - indexed for MEDLINE]
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