BACKGROUND:
The risk of hospitalization or complications associated with influenza in pediatric patients is significant. Hospitalization rates for infants with influenza less that 1 year of age are comparable to rates among persons age greater than 65 years. In order to decrease morbidity and mortality, vaccination programs in non-traditional settings need to be optimized. While influenza vaccination recommendations and guidelines have been established for pediatric patients, influenza immunization rates have been traditionally subobtimal.

OBJECTIVE:
Nearly 1/3 of all the Yale-New Haven Hospital pediatric influenza hospitalizations from 1999 to 2003 occurred in the 6-23 month age group. From October 2002 to February 2003, only 28 pediatric inpatients were ordered for influenza vaccine. During this time frame there were approximately 900 admissions for patients either age 6-23 months or > 23 months with chronic medical conditions, therefore our current immunization rate was not optimal. We endeavored to create a system which would ensure efficient patient assessment, vaccine prescribing, and vaccine administration and documentation for influenza vaccination.

METHOD:
An inpatient pediatric influenza vaccination assessment and protocol order entry system modeled after our pre-existing adult immunization program implemented in 2001 was developed and includes: 1) Electronic nursing admission assessment, 2) Pharmacist consult and protocol order activation, 3) Nurse, Pharmacist, and Physician education.

RESULT:
Implementation of our pediatric vaccination program began on November 1, 2003. Interim data analysis reveals that >90% of all pediatric admissions have completed vaccination assessments. Influenza vaccination protocol orders were entered for 298 (75%) of eligible patients.

CONCLUSION:
Standardized nursing vaccination assessment and protocol orders have increased vaccination rates at Yale-New Haven Hospital. We have experienced an 11-fold increase in prescribing of influenza vaccines for high-risk pediatric patients.

LEARNING OBJECTIVES:
Discuss automated inpatient assessment and protocol order system.
Identify barriers encountered after program implementation.