Impact of two different models on influenza and pneumococcal vaccination in hospitalized patients

Abstract

Objective: The Centers for Disease Control (CDC) recommends trivalent influenza (TIV) and pneumococcal (PPV) vaccination for eligible hospitalized patients. We conducted a retrospective study comparing two different methods of assessment and its impact on TIV and PPV vaccination in hospitalized patients.

Design: Two sequential models were compared in a community hospital for assessing patients' vaccination status and eligibility for TIV and PPV in an inpatient setting. In the first model (Model I), physicians were responsible for assessing eligibility and ordering TIV and/or PPV. In the second model (Model II), nurses were responsible for assessment and vaccination of eligible patients. Charts of hospitalized patients were randomly analyzed for completion rates of the assessment form, rate of vaccination, and documentation of the reason for not vaccinating eligible patients.

Results: A total of 138 charts were analyzed for Model I and 168 charts were analyzed for Model II. A significantly higher completion rate for assessment was noted for Model II compared with Model I (79.16% versus 34.78%, P < 0.001 for TIV; 72.02% versus 33.33%, P < 0.001 for PPV). Hospital vaccination rates were not significantly different between the two models for TIV (P = 0.625) and PPV (P = 0.689). A significant percentage of patients refused PPV in Model II [8.03% versus Model I at 3.2% (P = 0.04)].

Conclusion: A standing order protocol for assessing hospitalized patients' vaccination status by nursing staff and allowing them to vaccinate eligible patients without depending upon a physician order significantly improved the assessment compliance rate, but not the vaccination rates. Our findings suggest that a system-based method with nursing assessing the need for vaccination and a physician ordering the vaccination would probably have a higher potential for success.