The addition of a vaccine patrol team at Fairview Hospital led to an increased pneumococcal vaccination rate among adult inpatients. During a four week trial period, the vaccine patrol team, consisting of a nurse practitioner and intern, was able to administer pneumococcal vaccines to 75% of eligible adult inpatients. Common barriers to vaccination identified were inability to communicate with patients, nurses forgetting to order the vaccine, and patients being discharged before vaccination. The patrol team recommends modifications to the electronic medical record to help address these barriers and further increase vaccination rates.

1. Cleveland Clinic
Science Internship
Program for Nursing
Evaluation of a Vaccine Patrol Team to Increase Pneumococcal
Vaccination Rates among Adult Inpatients at Fairview Hospital
Katelyn Routhier, Maureen King MSN, CNP, Mary Beth Zeni, ScD, RN
Cleveland Clinic
Hypothesis
Methodology
• Annually, up to 50,000 American adults die from
vaccine preventable diseases, representing an
annual direct health care burden of $10 billion.
• Healthy People 2020 goal to increase the
percentage of adults vaccinated against
pneumococcal disease is 60% for adults’ ages
19-64 years with an eligible high risk condition,
and 90% for adults’ ages 65 years or older.
• Core Measures serve as standardized
performance practices for hospitals to provide
the best care. In 2012, immunizations (influenza
and pneumococcal) became one of these
Measures.
• Pneumonia carries a high morbidity and
mortality, is expensive to treat, and is
preventable through vaccination.
• What is the impact of the addition of a
vaccine patrol team to Fairview Hospital’s
adult inpatients during a four week period
(June 4 – June 29, 2012) on the number of
pneumococcal vaccines administered?
• An evaluative research study was conducted to
determine if implementation of a vaccine patrol
team would increase pneumococcal vaccination
(“pneumovax”) rates at Fairview Hospital among
adult inpatients.
• The vaccine patrol team includes the adult
nurse practitioner and the summer nursing
intern.
• A checklist was developed to document the
processes of the EPIC protocol for pneumovax
administration and to determine barriers to
vaccine administration.
• Quantitative data were collected from EPIC.
• Qualitative data were collected from
individual patients and nurses.
Data
• Data for 156 adult inpatients at Fairview Hospital were
collected during a four week period (June 4 – June 29,
2012) from EPIC the online medical record.
• Patients were selected from a list created to
include all patients who are eligible to receive the
pneumococcal vaccine.
• Patients were also selected by utilizing the EBI
Dashboard and emails sent from the registered
nurse in bed control.
• While extracting information from EPIC, patients and
nurses were interviewed during real time to identify
possible vaccination barriers.
Results
• In June 2012, 117 pneumococcal vaccines were
administered to 156 adults who qualified for the
pneumovax = 75% vaccination rate.
• 63 of 117 vaccines (54%) were administered to adult
inpatients between 18-64 years with chronic conditions.
• 54 of 117 vaccines (46%) were administered to adult
inpatients above 65 years.
Conclusions
Recommendations
• The vaccine patrol team recommends modifying
EPIC.
• Convert the single historical immunization
menu (under the immunization tab) from two
pull-down options to one.
• Initiate an automatic order to administer the
pneumovax if the vaccine is indicated per the
nursing assessment.
• Employ a “stop gap” at discharge if the
nursing administration assessment, regarding
the pneumovax, is incomplete.
• In summary, the addition of a vaccine patrol
team would help:
• Educate patients
• Educate nurses
• Increase the number of pneumococcal
vaccines administered
• Stabilize the Immunization Core Measure at
90-100%
• Common reasons for not administering the vaccine:
• RN unable to verbally communicate with patient
regarding vaccine since patient was intubated,
sedated, or demented
• RN forgot to order pneumovax
• RN unable to interpret patient’s medical history
regarding chronic illnesses therefore patient not
offered vaccine
• Patient discharged before opportunity for
administration
Adult Inpatients
between 18-64
years with Chronic
Condition(s)
Adult Inpatients
above 65 years
• Vaccination rates to patients 65 years and older
increased from 4% in June 2011 to 9% in June 2012.
• All data were de-identified for this quality research
project.
June
Data
Number of
patients above
65 years who
qualified for
vaccine
Number of
vaccines
given
Vaccination
rates
2011 712 30 4%
9%546172012
• Not all nurses are able to correctly navigate
EPIC to determine the patient’s need for
vaccination.
• Vaccines administered at an outside facility are
often not documented. Nurses are unable to
spend the time to recover the patient’s previous
vaccination history.