Background:

The pneumococcal vaccination has been shown to reduce the incidence of invasive pneumococcal infection by as much as 75%. Since approximately two‐thirds of patients hospitalized with serious pneumococcal infections have been previously hospitalized at least once during the previous five years, inpatient hospitalization represents an opportune time to provide screening and immunization.

Purpose:

To facilitate pneumococcal vaccination screening and immunization for all inpatients over age 65, a computerized provider order entry (CPOE) system was designed and implemented.

Description:

Prior to our initiative in January of 2005, approximately 3% of eligible inpatients at our institution were screened for pneumococcal immunization. Recognizing that this was below the national average of 38%, we convened a work group with representatives from medicine, nursing, pharmacy, and information support to develop a CPOE based program to improve pneumococcal immunization and screening.

Our CPOE program is designed to identify all inpatients over age 65 and provide a passive prompt to ordering providers suggesting pneumococcal screening and immunization. Selection of the prompt at any time during admission allows providers to order vaccine or document why vaccine will not be administered (e.g. patient refusal, prior immunization, or other). If no intervention has been made prior to the initiation of the CPOE discharge planning process, providers are automatically directed to address immunization status and/or order vaccine. Upon completion of a vaccine order and/or documentation of immunization status, corresponding information is updated in the patient's electronic record and permanently stored so that on subsequent admissions, no further ordering prompts will appear. Computerized acknowledgement of the order by nursing generates a medication administration label for documentation purposes as well as a vaccine information sheet for patients. Additional features include documentation prompts for nursing to confirm vaccine administration. If confirmed, both the patient's electronic record and discharge paperwork are updated to indicate the immunization status.

Summary of Results:

Implementation of a CPOE pneumococcal vaccine ordering program demonstrated an improvement in the screening/immunization rate from 3% pre‐implementation to 87% one month post implementation for patients age >65 with pneumonia, based on chart review. In the ensuing seven months, we have achieved and sustained a 77‐94% monthly screening/immunization rate. Preliminary data suggests that this benefit applies to all inpatients, not just those with pneumonia. As more hospitals increase CPOE use, consideration should be given toward applying this strategy toward inpatient immunization initiatives, as CPOE can be an effective tool to standardize practices that are otherwise prone to low compliance.

Author Disclosure Block:

A. Carbo, None; K. Cunningham, None; L. Saubermann, None.