New protocol for administering pneumonia vaccine could save lives, dollars

Requiring hospital nurses to identify patients who would benefit from pneumonia vaccine and providing pre-preprinted vaccination orders for doctors to sign can significantly reduce the physical and monetary costs of this common infection, according to a study published in the February issue of the American Journal of Preventive Medicine.

An effective and economical vaccine for invasive infections with Streptococcus pneumoniae, the most common cause of pneumonia, has been available since 1983, notes lead researcher Susan Ray, M.D., from the Emory University School of Medicine. Yet vaccination rates remain low, especially among non-white minorities and the elderly. As a result, as many as 30 people in 100,000 develop invasive infections (bloodstream infections, meningitis) with this pneumonia pathogen each year, almost half of them affected by expensive-to-treat antibiotic-resistant strains.

A favored protocol for improving vaccination rates among hospital patients, Ray explains, is a standing order that is, permission for nurses to identify good vaccination candidates and order the shots themselves. Unfortunately, some institutions believe that standing orders for hospital patients are precluded by their states medical act and as such would make them vulnerable to malpractice suits.

Working at one such instutition -- a public teaching hospital in Atlanta -- Ray and her colleagues examined the impact of an alternative system. The researchers added screening for pneumonia vaccination to the nursing staffs routine admitting procedures and added preprinted vaccine orders to patients charts on two hospital units. The nurses on those units flagged likely vaccination candidates for review by the doctors, who could rapidly authorize vaccination by signing the preprinted order.

The results showed that in the following month good candidates were 7.8 times more likely to receive the pneumonia vaccine on the test units than on two similar hospit

Contact: Tia Webster
Center for the Advancement of Health

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