Scheurer Danielle B, Cawley Patrick J, Brown Shirley B, Heffner John E
Brigham and Women's Hospital in Boston, Massachusetts, Department of Medicine and Hospitalist Medicine, 75 Francis Street, PB/B4/424, Boston, MA 02115, USA.
Am J Med Qual. 2006 Jan-Feb;21(1):18-29. doi: 10.1177/1062860605280314.
Inpatient pneumococcal vaccination remains underutilized, and little data exist to guide hospital personnel in improving their performance. The authors report their experience with a stepwise program to improve vaccination assessment rates for hospitalized patients with community-acquired pneumonia. They assessed barriers to vaccination and applied a stepwise educational and intranet-based decision support implementation program for hospitalized patients with community-acquired pneumonia. Preintervention vaccination rates were 0%. Primary nursing and physician barriers were assessed. An educational intervention increased vaccination assessment rates to 35%, a nursing decision-support tool to 42%, and approval of a standing order policy to 96%. For patients older than 65 years, vaccination assessment rates increased 33%, 67%, and 100%, respectively. An educational program combined with a decision support tool and a standing order policy can improve vaccination assessment rates to high levels. This study suggests that a multidimensional intervention is required to improve compliance with inpatient vaccination best clinical practices.
住院患者肺炎球菌疫苗接种的利用率仍然较低，而且几乎没有数据可指导医院工作人员提高其工作成效。作者报告了他们采用逐步推进计划提高社区获得性肺炎住院患者疫苗接种评估率的经验。他们评估了疫苗接种的障碍，并为社区获得性肺炎住院患者实施了一项基于逐步教育和内部网的决策支持实施计划。干预前的疫苗接种率为0%。评估了主要护理人员和医生方面的障碍。一项教育干预措施使疫苗接种评估率提高到35%，一项护理决策支持工具使其提高到42%，而一项长期医嘱政策的获批则使其提高到96%。对于65岁以上的患者，疫苗接种评估率分别提高了33%、67%和100%。一项结合了决策支持工具和长期医嘱政策的教育计划可以将疫苗接种评估率提高到很高的水平。这项研究表明，需要进行多维度干预以提高对住院患者疫苗接种最佳临床实践的依从性。
