Computerized orders effective in increasing administration of influenza and pneumococcal vaccines

Computer-based standing orders are more effective than computerized reminders to physicians in increasing influenza and pneumococcal vaccine administration for hospitalized patients, according to an article in the November 17 issue of JAMA.

According to background information in the article, few medical interventions rival influenza and pneumococcal vaccines in their ability to reduce illness and save costs and lives. Yet in the past, among individuals older than 65 years, as many as 34 percent have not received their annual influenza vaccine and 38 percent have not received their annual pneumococcal vaccine. Computerized reminder systems increase influenza and pneumococcal vaccination rates, but computerized standing order systems have not been previously evaluated.

Paul R. Dexter, M.D., of Wishard Memorial Hospital and Indiana University School of Medicine, Indianapolis, and colleagues compared the effects of computerized standing orders for influenza and pneumococcal vaccines in a randomized trial using the computerized physician reminder system as a control. The trial included 3,777 general medicine patients discharged from 1 of 6 study wards during a 14-month period (November 1, 1998, through December 31, 1999) composed of 2 overlapping influenza seasons at an urban public teaching hospital.

The hospital's computerized physician order entry system identified inpatients eligible for influenza and pneumococcal vaccination. For patients with standing orders, the system automatically produced an order directing a nurse to administer the vaccine at time of discharge. For patients with reminders, the computer provided reminders to physicians that included vaccine orders during routine order entry sessions.

During the approximately 6 months of the influenza season, 50 percent of all hospitalized patients were identified as eligible for influenza vaccination. Twenty-two percent of patients hospitalized during the entire 14 months of t

Contact: Mary Hardin
JAMA and Archives Journals

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