KEYWORDS:
pneumococcal vaccination, standing order policies, nursing homes, vaccination coverage

BACKGROUND:
Pmeumonia is the third most frequent cause of hospitalization among Medicare beneficiaries in Washington State. While a vaccine against pneumococcal disease has been available since 1997, the 1999 BRFSS estimates that less than 56% of adults 65 and older in Washington State have been immunized.

OBJECTIVE:
To assess the prevalence of standing order and other written policies and estimate pneumococcal coverage rates in Washington's nursing homes as well as to increase the use of standing orders and increase vaccination coverage in this vulnerable population.

METHOD:
To assess nursing home pneumococcal policies, we surveyed all Washington nursing homes in 1999 and, subsequent to an educational intervention, we re-surveyed the facilities in 2001 to assess any policy changes that occurred during the intervening period. Following the policy surveys, we conducted assessments to estimate pneumococcal vaccination coverage of a random sample of residents of Washington nursing homes.

RESULT:
The use of standing orders or other written pneumococcal policies by nursing homes in Washington State increased by 14% from 58% in 1999 to 72% in 2001. Pneumococcal vaccination coverage for residents of those nursing homes also increased from 47% in 2000 to 61% in 2002. Overall, residents in 2002 were 76% more likely to have received pneumococcal vaccinations than in 2000 (OR=1.76, 95% CI: 1.49, 2.07). The important finding of this project is that residents at facilities with standing orders or written policies in 2000 and 2002 were almost three times more likely to have received pneumococcal vaccine than residents at facilities with no policies.

CONCLUSION:
Increased use of standing orders and other written policies has contributed to higher rates of pneumococcal vaccination in Washington State nursing facilities.

LEARNING OBJECTIVES:
To understand ways of estimating the use of policies and vaccine coverage in nursing facilities as well as techniques that contribute to increased immunization rates.