Denise R. Sokos1, Kelly Ervin
2, Debra Santarelli
3, Carolyn Griffin
3, Donald B. Middleton
4, Richard K. Zimmerman
5, and Susan J. Skeldar
2. (1) Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, 302 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, USA, (2) Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center, Pittsburgh, PA 15241, PA, USA, (3) Nursing Administration, University of Pittsburgh Medical Center, Pittsburgh, PA, USA, (4) Family Medicine, University of Pittsburgh, Pittsburgh, PA, USA, (5) Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
BACKGROUND:
Pneumococcal disease causes significant morbidity and mortality annually in the United States. A physician reminder pneumococcal polysaccharide vaccine (PPV) immunization program had been in place at our institution since 2000. At its peak, vaccination rates reached 38%. In 2002, the Centers for Medicare and Medicaid Services published a final rule removing the federal barrier of a physician order for influenza vaccine and PPV in hospitals. This ruling allowed implementation of a vaccine standing order program (SOP) at our facility.
OBJECTIVE:
The aim of this project was to redesign and implement an inpatient SOP for PPV to achieve the Healthy People 2010 immunization goal of 90% of elderly ever vaccinated.
METHOD:
A multidisciplinary expert panel was assembled to design the SOP. Action steps included identifying obstacles in the existing program; identifying healthcare staff responsible for patient risk assessment/order writing; designing implementation tools; and ensuring ongoing quality assessment. Challenges with the existing program were at all steps of the medication use process. Pharmacy staff performed risk assessment/order writing and program quality measurement. Implementation tools included a combined risk assessment/vaccine order form, nursing charting aids, hospital SOP policy, and vaccine dispensing kits.
RESULT:
Over 700 patients per month have been evaluated since SOP inception. The vaccination rate has jumped more than six-fold to 63%. Early post implementation, the percentage of omitted doses peaked at 37%, due to unclear order transcription and practitioner concern with intramuscular injections. With focused education and continual program revision, this rate has decreased to 20%.
CONCLUSION:
Vaccination rates have improved, but are still below the national goal. Important steps in the process were the development of the risk assessment/order form, defining the responsibility of program maintenance, and real time problem solving and education.
LEARNING OBJECTIVES:
1. List the steps in designing an inpatient SOP.
2. Discuss challenges that must be overcome for a successful inpatient SOP.
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