ReviewA review of acute care interventions to improve inpatient pneumococcal vaccination

- Hospital-based interventions can increase pneumococcal vaccination rates.
- Hospital studies show highest pneumococcal vaccination rates with standing orders.
- Other interventions (e.g. chart reminders) also increase vaccination rates.
- There are few well-designed studies to determine the best approach for hospitals.

ObjectiveTo provide a narrative review of the impact of provider-based, organizational strategies in acute care settings to improve pneumococcal vaccination rates among patients over 65, and 2-64 years with high risk medical conditions.MethodsA search was conducted using MEDLINE, Scopus, CINAHL and Web of Science databases for hospital-based, inpatient studies which evaluated strategies to improve pneumococcal vaccination rates. Studies published in English from 1983 to 2013 were included. Data abstracted was analyzed descriptively.ResultsA total of 35 studies were included; 15 evaluated physician reminders (e.g. chart or paper reminders, pre-printed orders (PPOs), computerized reminders, checklists) and 21 standing orders programs (SOPs). The most common study design was pre/post, and only 7 studies had a control group. Overall, 32 studies showed improvements in the rate of pneumococcal vaccination following intervention (19 statistically significant), with reminders showing 29-74% immunization rate, PPCO 5-42%, and SOPs 3.4-78%.ConclusionHospital-based interventions improve pneumococcal vaccination in older adults and younger individuals at risk. Although this review found that more success was observed with SOPs the impact on immunization rates in eligible patients varied significantly. Thus, high quality, randomized-controlled studies are required to determine the effect of each type of institutional immunization strategy.