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Standing Orders for Inpatient Vaccination

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... Vaccination Rates for Mass. Adults. MA BRFSS. Standing ... Pneumococcal Information. Links to CDC sites. www.mass.gov/dph/flu. Influenza Information ... – PowerPoint PPT presentation

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Title: Standing Orders for Inpatient Vaccination


1
Standing Orders for Inpatient Vaccination
  • Donna Lazorik, MS, RN
  • Immunization Program
  • Massachusetts Department of Public Health
  • June 2006

2
Pneumococcal Vaccination Rates for Mass. Adults
MA BRFSS
3
Standing OrdersRationale
  • Flu and pneumococcal vaccines are under-utilized
    in institutions
  • Standing orders more effective than other
    institution-based strategies
  • Standing orders effective in hospitals, LTC
    facilities, and out-patient settings

HCFA and CDC, 1999 NVAC and ACIP, 2000
4
MMS Committee on the Quality of Medical Practice
and Committee on Public Health
  • Consensus
  • Standing orders are clinically sound.
  • Implementation will improve clinical outcomes and
    reduce unnecessary utilization and health care
    costs.
  • Issues of informed consent addressed via federal
    protections

Elaine Kirshenbaum, MPH MMS
5
Recommendations
  • Identify persons eligible for vaccination (age,
    vaccination status, medical condition)
  • Provide information on risks and benefits and
    document delivery of information
  • Record patient refusals or medical
    contraindications

Elaine Kirshenbaum, MPH MMS
6
Standing Orders in Hospital
  • Endorsed by
  • Massachusetts Medical Society
  • Massachusetts Hospital Association
  • MassPRO
  • Massachusetts Department of Public Health

7
Obstacles to inpatient vaccination
  • Unclear screening process
  • Determining eligibility
  • Getting vax from the pharmacy
  • Timing of screening/vaccination
  • MD order (necessary)

8
Obstacles to inpatient vaccination
  • Nsg reservations about protocol
  • ? Safety of in-patient vaccination
  • Unclear vax history

9
MA BORN
  • Standing orders must include
  • Agent to be administered
  • Dose
  • Method /rte of administration
  • Assessment factors
  • Documentation required

10
MA BORN
  • Standing orders must include
  • Client education
  • VIS
  • Opportunity to ask questions
  • Procedure for informed consent
  • Same as above
  • Some facilities require signature
  • Provision of tx of adverse events
  • Signature of authorized prescriber

11
SO Protocol - recommendations
  • Standing order should by signed once
  • Copy placed in every chart
  • Reviewed and re-signed annually

12
Myth 1
Its dangerous to vaccinate people in the
hospital.
13
PPV23 True Contraindications
  • Anaphylactic reaction to
  • previous dose of PPV23
  • any other component of the vaccine
  • (see package insert)
  • Pneumovax (Merck) contains NO thimerosal or latex

14
PPV23 Precautions
  • Any febrile respiratory illness or other active
    infection, except when withholding the agent
    entails even greater risk. (package insert)

15
Adverse EventsPPV23 vs. Pneumococcal Disease
  • Adverse events from PPV23
  • Local reactions 30 - 50
  • Fever, malaise lt 1
  • Severe allergic reactions very rare
  • Adverse events from pneumococcal disease
  • Pneumonia
  • 175,000 hospitalizations CFR 5 7, higher in
    the elderly
  • Bacteremia
  • 50,000 cases CFR 20 - 60
  • Meningitis
  • 6,000 cases 30- 80 CFR neurologic sequelae
    common in survivors

16
  • It is much more dangerous to get pneumococcal
    disease than to get vaccinated.
  • gt 90 of all newborns are vaccinated prior to
    discharge.

17
Myth 2
I cant vaccinate my patient unless I have a good
vaccination history.
18
When in doubt, vaccinate!
19
Myth 3
Patients dont want to get vaccinated in the
hospital.
20
Why Medicare Beneficiaries Didnt Get
Pneumococcal Vaccine
  • 57 Didnt know it was needed
  • 13 Doctor didnt recommend it
  • 11 Didnt think of it/missed it

(CDC. MMWR 199946886-890.)
81 would have gotten vaccinated if their HCP
told them to!
21
The recommendation of a HCP is the single most
important determinant of whether or not some one
gets vaccinated.
22
MDPH Flu Web Site
  • Link to MassPRO flu clinic site
  • Consumer Information
  • Provider Guidelines
  • Pandemic Planning
  • Pneumococcal Information
  • Links to CDC sites

www.mass.gov/dph/flu Influenza Information
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