BACKGROUND:
Inpatient influenza and pneumococcal vaccination for high risk adults remain a significant missed opportunity. Beginning in June 2003, six Michigan hospitals worked collaboratively with CDC to encourage inpatient immunization policies, including standing orders protocols.

OBJECTIVE:
To report findings of hospital chart abstraction comparing vaccination rates before and after implementation of inpatient immunization policies.

METHOD:
We randomly sampled charts from the four hospitals that instituted immunization policies during 2003. At each hospital, we requested 400 charts: 100 charts each for patients aged 50-64 years discharged November 2002 and November 2003, and 100 charts each for patients aged 65+ years discharged November 2002 and November 2003.

RESULT:
Among patients eligible to be vaccinated because they had not already received vaccine and had no vaccine allergies, inpatient influenza vaccination in 2002 vs. 2003 was 0.5% v. 10.5% (Hospital A), 0.9% vs. 14.1%% (Hospital B), 2.9%% vs. 10.6% (Hospital C), and 9.2% vs. 7.9% (Hospital D). Inpatient pneumococcal vaccination in 2002 vs. 2003 for eligible patients aged 65+ years and aged 50-64 years at high risk for pneumococcal disease was 0% vs. 11.36% (Hospital A), 1.0% vs. 19.6%.(Hospital B), 1.7% vs. 8.3% (Hospital C), and 2.6% vs. 4.5% (Hospital D). Vaccine assessment forms were found in 57.4% of charts abstracted for 2003; however, almost 1/3 (29.3%) of assessment forms were incomplete. Challenges to implementing immunization policies included support and training of hospital staff, interpretation of ACIP recommendations, documentation of assessments, tracking of immunizations, and vaccination cost reimbursement.

CONCLUSION:
Vaccination increased when hospitals initiated inpatient immunization policies in 2003, yet inpatient vaccination rates were low. Strategies for overcoming inpatient immunization challenges in non-research settings need to be evaluated.

LEARNING OBJECTIVES:
To describe possibilities for inpatient immunization and identify what is needed to implement effective hospital standing orders programs.