This study was a retrospective, preintervention and postintervention evaluation of influenza and pneumococcal vaccination among hospitalized patients eligible for vaccination. The authors abstracted 1476 randomly sampled patient charts to compare vaccination before (2002) or after (2003) implementation of vaccination policies in 4 Michigan hospitals. In addition, they assessed completeness of vaccine assessment forms, evaluated reasons for nonvaccination, and conducted interviews with hospital staff. Vaccination increased at 3 of 4 hospitals after implementation of vaccination policies, yet rates remained low (<10% overall; range, 3.4%-12.4%). Vaccine assessment forms were found in most of the charts in 2003, but almost a third were incomplete. Challenges to implementing inpatient vaccination included support and training of hospital staff, interpretation of vaccination recommendations, lack of systematic prompts for vaccinations, and cost reimbursement. These findings underscore the need for continuous quality improvement and process monitoring to determine strategies for overcoming challenges to inpatient vaccination.
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Lawson F, Baker V, Au D, McElhaney JE. Standing orders for influenza vaccination increased vaccination rates in inpatient settings compared with community rates. J Gerontol A Biol Sci Med Sci. 2000;55A:M522-M526.
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Dexter PR, Perkins SM, Maharry KS, et al. Inpatient computer based standing orders vs. physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA. 2004;192:2366-2371.
18.
Centers for Medicare and Medicaid Services. Medicare and Medicaid programs; conditions of participation; immunization standards for hospitals, long-term care facilities, and home health agencies. Available at: http://www.cms.gov/providerupdate/regs/cms3160fc.pdf. Accessed February 11, 2005.
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Centers for Medicare and Medicaid Services. Standing Orders for Influenza and Pneumococcal Immunization. Washington, DC: Centers for Medicare and Medicaid Services; 2002. CDROM and documents available at: http://www.tmf.org/immunization/cd/index.htm, http://www.ofmq.com/downloadables.php, http://www.nmmra.org/providers/resources_orderform.php.
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Centers for Disease Control and Prevention. Adult Clinical Assessment Software Application (ACASA) User Tools Manual, version 3.0.1. Atlanta, Ga: Centers for Disease Control and Prevention; 2004. Available at: http://www.cdc.gov/nip/casa/acasa/a_userguide/acasa_usertools301.pdf. Accessed February 11, 2005.
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Kissam F, Gifford DR, Patry G, Bratzler DW. Is signed consent for influenza or pneumococcal polysaccharide required?Arch Intern Med. 2004;164:13-16.
23.
Meurer SJ, Counte MA, Rubio DM, Arrington B.Measuring a hospital's ability to improve. Am JMed Qual. 2004;19:214-222.
24.
Centers for Medicare and Medicaid Services. Medicare program: revisions to payment policies under the physician fee schedule for calendar year 2005. Available at: http://www.cms.hhs.gov/providerupdate/regs/cms1429fc_4.pdf. Accessed February 11, 2005.
