PURPOSE: To increase the number of hospitalized patients who receive the influenza vaccine and to decrease the number of patients hospitalized with Community-Acquired Pneumonia.
BACKGROUND: Community Acquired Pneumonia (CAP), severe enough to require hospitalization, may be precipitated by influenza. The Centers for Disease Control (CDC) recommends that hospitalization be used as an opportunity for vaccination. Twenty-three percent of patients admitted to our hospital in January 2000 for CAP had been hospitalized within the previous three months (representing an opportunity for vaccination). Fifteen influenza vaccinations in high-risk populations have been shown to prevent one hospital admission (usually for pneumonia). During the fall of 1999 strategies attempted at this institution including chart stickers, posted reminders and, presentation at clinical rounds, produced a small increase in the flu vaccination rate. The research literature shows that the most effective way to increase inpatient vaccination rates is through the use of designated nurses to provide this service.
METHODS: During the fall of 2000, funding was obtained from the medical center’s foundation to pay for a Registered Nurse to screen, using the CDC’s criteria, and administer the flu vaccine to inpatients under a standing order. Physicians were given the option to exclude their patients from this project. The vaccine was offered to all patients who met the criteria and who signed a consent form. The pilot project began with the availability of the vaccine on October 23, 2000 and ended December 13, 2000. Patients admitted during January 2000 – 2001 with CAP were identified retrospectively through SoftMed (a medical records program). The computer based record for each patient admitted in January was then searched by the author to identify whether the patient had been hospitalized at our institution within the previous four months. Data collection for the vaccination project, e.g. number of patients screened, number who received the vaccine, type of medical contraindication etc. was recorded concurrently by the RN giving the vaccine. Total number of vaccinations administered was available, retrospectively, through Trendstar, our clinical cost accounting system.
FINDINGS: Registered Nurse Project volume: Patients screened for appropriateness N=562; received vaccine prior to admission N=103; received vaccine through the RN project N=145 (32%); did not receive the vaccine N=314 (68%); reasons for not receiving vaccine: medical contraindication N=123; patient refused N=116; language barrier N=11; on MD non-participation list N=11; missing data N=53 Total hospital influenza vaccine volume (includes RN Project and physician orders) N=252 (300% increase) as compared to 1999 volume N=77. Effect on January CAP admissions: January 2001: total CAP admissions N=32; patients hospitalized within previous three months N=4 (13%). January 2000: total CAP admissions N=57; January CAP patients hospitalized within previous three months N=13 (23%).
CONCLUSIONS: We significantly increased the number of inpatients who received the influenza vaccine. According to one study, 17 hospital admissions may have been prevented by this effort. Much of this increase was due to the designated vaccination nurse. However, the physicians increased the volume of their patients for whom they ordered the influenza vaccine by 39% over 1999. This may have been due to the increased awareness created by the project. Although the percentage of patients who were admitted in January for CAP who had been hospitalized in the previous three months was decreased, overall pneumonia admissions were decreased as well.
IMPLICATIONS: In response to economic pressure several hospitals in our area have merged or closed thereby reducing the number of available beds. Coupled with the nursing shortage, the increase in patient admissions due to pneumonia and other respiratory disorders during the winter months has placed a strain on the entire system. The CDC has requested hospitals to take advantage of inpatient hospitalization to offer vaccines. However, our experience has been that a preventive approach to patient care is not at the top of a physician’s priority list during an acute admission. In order to change practice and combine preventive measures with acute care management, creative strategies need to be employed.
Back to Instruments and Strategies to Promote Health
Back to The Advancing Nursing Practice Excellence: State of the Science