KEYWORDS:
Adult Immunization

BACKGROUND:
Influenza and pneumococcal disease are the fifth leading cause of death in the elderly and increasingly contribute to morbidity in high risk patients. In order to decrease morbidity and mortality, vaccination programs in non-traditional settings need to be optimized. Literature has proven that simply educating health-care providers and providing reminders do not provide adequate increases in vaccination rates.
From October 2000 to March 2001, 100 elderly inpatients were vaccinated against influenza and pneumococcal diseases at Yale-New Haven Hospital. Considering that during this time frame there were approximately 12,000 admissions for patients greater than 50 years of age, our current immunization rate was unacceptable. We endeavored to create a system which would ensure efficient patient assessment, vaccine prescribing, and vaccine administration and documentation.

OBJECTIVE(S):
Our goal is to increase influenza and pneumococcal vaccination rates of high risk patients to 70% and improve documentation of vaccination assessment and history.

METHOD(S):
A multi-disciplinary group, led by a six sigma trained facilitator, identified barriers to inpatient immunization and developed solutions for improving the immunization process. Solutions included standardized assessment screening, ordering processes through the utilization of protocol driven order sets, and providing education to healthcare providers and patients.

RESULT(S):
Implementation of our vaccination program began on November 1, 2001. Interim data analysis reveals that 1140 patients have been ordered vaccinations. Our first evaluation of assessment documentation revealed that 88.4% of all adult patients had complete immunization assessments.

CONCLUSIONS(S):
Standardized nursing vaccination assessment and protocol orders have increased vaccination rates at Yale-New Haven Hospital. We have experienced a 497% increase in prescribing of pneumococcal and influenza vaccines. The utilization of the protocol order pathway accounts for 84.8% and 80.9% of pneumococcal and influenza vaccine orders in our adult population.

LEARNING OBJECTIVES:
Describe process for immunization program development.
Discuss barriers encountered after program implementation.
Explore future program enhancements.