Computer assisted standing orders improve adult immunization rates

INDIANAPOLIS Computer-assisted standing orders for nurses significantly improve influenza and pneumonia immunization rates for adult hospital patients. According to the authors of a new study, this approach should have broad application to a wide range of preventive care interventions such as cancer and osteoporosis screening in non-hospital settings.

In the study published in the Nov.17 issue of the Journal of the American Medical Association, Paul Dexter, M.D., and Clement McDonald, M.D., and their Indiana University School of Medicine and Regenstrief Institute, Inc. colleagues report that computer-assisted standing orders for nurses achieve even higher rates of adult inpatient immunization than computerized physician reminders.

In a previous study published in the New England Journal of Medicine, the same researchers demonstrated that computerized reminders delivered to physicians increased inpatient ordering rates of influenza and pneumonia vaccine dramatically (approximately 50 fold) over non-reminded rates, but fell far short of national vaccination goals.

"Computerized physician reminders would be the preferable approach when physician judgment is required, but decisions about many safe interventions like the administration of flu and pneumonia shots and cancer screening that are based largely on simple criteria such as patient age and diagnoses can be done better by nurses following computer based standing orders," said Dr. Dexter, associate professor of clinical medicine.

The computer can do all the work of scrutinizing the medical record to find the patients who need the preventive care intervention and then signal the nurse about them. The nurse can then verify the criteria with the patient and deliver the intervention. This improves the delivery of care and frees physicians to concentrate on more complex and severe patient problems explained Dr. Dexter.

"For many vulnerable populations who ar

Contact: Cindy Fox Aisen
Indiana University

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