Say No to Pneumonia: A Quality Improvement Study to Increase Pneumococcal Vaccination Rates

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Primary Author:</td>
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Rebecca C. Clark, PhD, RN</td>
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Co-Principal Investigators/Collaborators:</td>
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<p align="left">Julie Jackson, RN, Debby Hodges, BSN, RN, Brenda Gilliam, MA, RN, Jenny Lane, MS</p>
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Organization:</td>
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Carilion Clinic</td>
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Abstract</h2>
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Purpose</h3>
<p>To improve the immunization rates of an at-risk adult population, seen in an ambulatory environment, through staff training and targeted, evidence-based patient education. </p>
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Background</h3>
<p>Centers for Disease Control (CDC) recommend adults 65 years of age and older, those with chronic diseases and/or smokers receive pneumococcal vaccination. In our pre-surgical testing center, we assess over 12,000 patients annually and 15% of this population meets the Centers for Disease Control “at risk” criteria of age and/or chronic disease for pneumonia. We were immunizing only 24 %.</p>
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Materials & Methods</h3>
<p>We implemented a two-phase quality improvement study, implementing evidence-based strategies to modify staff and patient behaviors.<br />
In Phase 1, staff taught patients the benefits of immunizations and immunized those interested. Staff received monthly feedback on rates. In Phase 2, patients received a one-page educational flyer in their folders prior to meeting with a nurse during their presurgical testing visit. We compared immunization rates for 12 months before and following the intervention, using measures of continuous, repeated observations to control for seasonal variations in immunization patterns. </p>
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Results</h3>
<p>There were 2,257 eligible patients pre-intervention and 2505 in the intervention. The pre-intervention immunization rate was 24%. The post-intervention rates was 47%, a statistically significant difference ( X2(1, N=4736)=173.8, p<.0001). Patient ages ranged from 17 to over 84 years. The most common eligibility criteria were chronic conditions 19-64 years old (31%), 65 years or older (28%), and current smoker 19-64 years old (26%). The post-intervention data showed no significant relationship between vaccination and gender. Both males and females had significant changes in vaccination rate pre and post-intervention. While all age groups showed significant relationship when comparing vaccination rate pre and post-intervention, the intervention appeared to have a greater impact on ages 45 and older.</p>
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Conclusion</h3>
<p>Appropriate immunization of at-risk patients in ambulatory settings can have an important health impact. Active staff education of patients can significantly improve immunization rates. Patient education flyers had minimal impact.</p>
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Bibliography</h3>
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Smith, J. and Metzger, N. (2011). Evaluation of pneumococcal vaccination rates after vaccine protocol changes and nurse education in a tertiary care teaching hospital. Journal of Managed Care Pharmacy, 17 9) 701-708.</li>
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Centers for Disease Control and Prevention. Vaccines and preventable diseases. Available at http://www.cdc.gov/vaccines/vpd-vac/pneumo/default.htm. Accessed October 3, 2013.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>