Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. List 3 barriers to compliance with Standing Orders
2. Identify 3 methods used to remove barriers
3. Apply proactive educational methods to their practice


Background:
The Immunization Standing Orders Regulation was published in the Federal Register October 2, 2002, which allows for hospitals, nursing homes and home health agencies to use Standing Orders to immunize their patients.


Setting:
Chelsea Community Hospital, Chelsea, MI. 113 Beds.


Population:
Inpatients on Intensive Care, Medical-Surgical and Physical Rehabilitation Units were selected for screening for Pneumococcal and Influenza vaccines.


Project Description:
A Medical Record audit was performed for 2003-2004 and it was establsihed that the policy goal rate of 90% vaccination was not achieved. Input from nursing and pharmacy staff identified 3 barriers to compliance: 1) missed doses when patient was febrile; 2) confused/ill patients unable to provide history; 3) discharge to other units. Changes were made to the Standing Order instructing the nurse to carry-over the order on the MAR for the next shift. Vaccination history was entered in a database and indicated on the Face Sheet. Nurses were invited to lunch and learn about the vaccine. Flyers sent to nursing highlighted Standing Order changes and the location and use of the vaccination history field on the Face Sheet. Prizes were given for completion of a self grading informational quiz.


Results/Lessons Learned:
Demands on nurse's time may be a factor in compliance with policy. Identifying and removing barriers to history taking, providing a method to aid delivery of vaccine when patients are febrile/ill and discharged to other units and education will stimulate interest and compliance with policy.