Background:
The Joint Commission and the Centers for Medicare and Medicaid Services developed Core Measures for community-acquired pneumonia in 2004. Since this time, vaccination status has been the responsibility of the nurse, using our hospital-wide standing order policy. Core Measures compliance involves screening and administration of the pneumococcal vaccine prior to discharge when indicated for patients 65 years and older with a working diagnosis of pneumonia. Our goal is to incorporate best practice for our community by screening and vaccinating adult inpatients 19 years and older. Screening and documentation of vaccine status are performed by the nurse while completing the admission assessment in the electronic medical record (EMR). On the basis of this screening, the nurse then communicates vaccine need to the pharmacy, which then prepares and delivers the dose to the nursing unit. Once administered, this dose is documented in the EMR.
Evaluation:
Data collected and analyzed by our senior compliance analyst, based upon random chart reviews, found vaccine screening maintaining a positive trend above 87% since January 2005. However, during this period, administration of the vaccine to those patients meeting Advisory Committee on Immunization Practices criteria suffered a rapid decline to as low as 10% compliance in April 2007. Nursing staff reported that the process for obtaining the vaccine was cumbersome, requiring a memory step to go outside of the EMR to notify the pharmacy of a need to vaccinate. Also, data show a continued negative trend below 40% compliance in screening and vaccinating prior to discharge for those patients who could not be screened on admission.
Interventions:
Through collaboration among nursing, pharmacy, physicians, and information services, order communication forms generated from the EMR were created and implemented in June 2007. These forms are based on a logical analysis of nursing documentation in the EMR, which determines which forms will be generated and on which printer. These forms direct pharmacy staff in entering vaccine and screening reminder orders, which appear on the patient's EMR medication work list. The nurse will document vaccine administration, and the vaccine screening reminder order serves as a prompt to screen the patient who could not be screened on admission.
Results:
Recent data show notable improvement in screening prior to discharge and vaccine administration resulting from the utilization of this new logic-based communication method.