The impact of order set use on pneumococcal vaccination at the time of admission and at the time of discharge for adult patients in an acute inpatient setting

Abstract

Background: Pneumococcal vaccination (PV) is important as Streptococcus pneumoniae accounts for one third of all hospitalizations for community-acquired pneumonia. In 2009, 1.1 million people in the U.S. were hospitalized with pneumonia and more than 50,000 people died from the disease. The Centers for Disease Control and Prevention recommend that PV be administered to all patients 65 years or older as well as to younger patients with chronic diseases. Many hospitals are struggling to achieve the National Healthy People 2010 target of a 90% vaccination rate. Computerized provider order entry with use of order sets can help to achieve compliance with vaccine guidelines. In an acute teaching hospital, in an effort to improve PV rates, Pneumococcal Vaccine and Screening Orders (PVSO) were incorporated into the Admission Order Set (AOS) on September 15th, 2008. Before this time period, PVSO was part of the Discharge Order Set (DOS). Purpose: The major goal of this study was to compare the impact of the use of PVSO on pneumococcal vaccination when used at the time of admission and when used at the time of discharge for adult patients in an acute inpatient setting. The secondary goal was to examine factors associated with vaccination with both types of order sets. Methods: A retrospective pre and post design was used for this study. Patients who were discharged from 7 medical inpatient units during the months of March 2008 and March 2009 were included. The sample included 420 DOS cases and 420 AOS cases. Data were analyzed using descriptive statistics to describe the sample's vaccination status using PVSO at admission and at discharge. Chi-square tests were conducted to compare the effect of the use of PVSO between AOS and DOS on PV. Logistic regression was used to examine the influence of patient demographic variables, discharging unit, primary diagnosis, and type of order set on PV administration status. The influence of age group, sex, race, length of stay, and order set type on PV status was also evaluated using generalized estimating equations to adjust for dependency within units. Results: The findings from this study suggest that there is no difference in rate of vaccine administration between vaccines ordered at the time of admission or at the time of discharge. Age and race were significant predictors of vaccine administration. Patients who were 65 or older were more likely to receive vaccination than younger patients. Minorities were more likely to get vaccinated than Caucasians. Rates of PV differed in the different units. Conclusion: Recent advancement in health information systems can have positive impact on clinical practice. When those technologies are implemented, their outcomes must be assessed. This study examined the impact of changes in PV ordering practice assisted by order sets. Findings showed no significant difference in PV according to time of ordering the vaccine. PV rates, however, were influenced by patients' age and race. Younger adults seem to be less likely to be vaccinated than older adults. Providers may need education to identify risk factors in younger adults and training to use appropriate ordersets.Vaccine compliance rate was not evaluated as the exact number of eligible patients could not be determined for DOS. Findings suggest that a combination of technology and human factors are needed to successfully implement vaccine guidelines.