Statement of the problem: Pneumococcal infection is responsible for more than 4000 deaths annually in the United States, with one-half of the deaths occurring in individuals 65 years or older. For hospitalized patients, vaccination rates are inadequate. Therefore, healthcare organizations are implementing technological solutions to improve the vaccination rate.
Specific aims of research: The aims of this study were to (1) identify the frequency of screening and administration of the pneumococcal vaccine before and after the implementation of the clinical decision support (CDS) program and (2) identify the factors associated with patients who are screened, but not vaccinated.
Setting and sample: The setting was an academic medical center in Pacific Northwest. The sample for the study consisted of 200 randomly selected records from the 1364 records (pre-CDS intervention) and 200 records from the 1407 admissions (post-CDS intervention).
Intervention, if any: None
Data collection procedures: A structured data collection form to record the following variables: age, sex, race, admitting diagnosis, date of admission, date of discharge, ward location, completion of pneumococcal vaccination assessment, date of completed pneumococcal vaccination assessment, receipt of pneumococcal vaccination, and factors associated with nonreceipt of vaccination.
Data analysis methods: This retrospective and randomized chart review targeted all inpatients 65 years or older admitted from September 2007 through January 2008 (before implementation CDS, T-1) and September 2008 through January 2009 (after implementation of the CDS rule, T-2). A random sample of 200 patients was selected of 1364 and 1407admissions in T-1 and T-2, respectively. There were no significant differences in demographic characteristics between the 2 groups.
SPSS 17.0 statistical software package was used to determine frequencies and to perform t tests. VassarStats software was used to compare pneumococcal assessment and vaccination rates ([chi]2).
Findings: Implementation of the CDS program significantly increased the completion rate of the assessment from 56.0% to 89.0% ([chi]2 = 54.62, P < .0001) and increased the pneumococcal vaccination rate from 9% to 17.5% ([chi]2 = 6.29, P = .018). The most frequent reasons for not administering the vaccine were previously received (T-1, 58.5%; T-2, 75.5%), patient refusal (T-1, 25.5%; T-2, 18.0%) and concurrent or recent bone marrow transplant, chemotherapy, or radiation (T-1, 12.8%; T-2, 8.6%). There were no reports of allergies or adverse reactions in either time frame.
Discussion and conclusions or recommendations: Despite the implementation of technological solutions, the assessment and administration of the pneumococcal vaccine continue to be inadequate for the at-risk hospitalized population. This study demonstrated that with a two-prong approach, the CDS rule and nurse manager reports lead to an overall increase in pneumococcal vaccination assessments and administration.
Contact the corresponding author: Gerilyn T. Corpuz ([email protected])