Overcoming Barriers to Establishing an Inpatient Vaccination Program for Pneumococcus Using Standing Orders

2005 ◽  
Vol 26 (11) ◽  
pp. 874-881 ◽  
Author(s):  
Donald B. Middleton ◽  
Dwight E. Fox ◽  
Mary Patricia Nowalk ◽  
Susan J. Skledar ◽  
Denise R. Sokos ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Pneumococcal Vaccination ◽  
Vaccination Rate ◽  
Vaccination Program ◽  
Successful Implementation ◽  
Close Monitoring ◽  
University Of Pittsburgh ◽  
Vaccination Rates ◽  
The University

AbstractObjectives:To identify and classify barriers to establishing a standing orders program (SOP) for adult pneumococcal vaccination in acute care inpatient facilities and to provide recommendations for overcoming these roadblocks. Vaccination rates in hospitals with SOPs are generally higher than those in hospitals that require individual physician orders. The array of solutions drawn from our experience in different hospital settings should permit many types of facilities to anticipate and overcome barriers, allowing a smoother transition from initiation to successful implementation of an inpatient pneumococcal vaccination SOP.Design:Descriptive study of barriers and solutions encountered during implementation of a pneumococcal vaccination SOP in three hospitals of the University of Pittsburgh Medical Center Health System (UPMC) and in the scientific literature.Setting:As of 2004, two UPMC tertiary-care hospitals and one UPMC community hospital had incorporated SOPs into existing physician order-driven programs for inpatient vaccination with pneumococcal polysaccharide vaccine.Results:Barriers were identified at each step of implementation and categorized as patient related, provider related, or institutional. Based on a process of continual review and revision of our programs in response to encountered barriers, steps were taken to overcome these impediments.Conclusions:A strong commitment by key individuals in the facility's administration including a physician champion; ongoing, persistent efforts to educate and train staff; and close monitoring of the vaccination rate were essential for successful implementation of a SOP for pneumococcal vaccination of eligible inpatients. Legal statutes and evaluations of external hospital-rating associations regarding the effectiveness of the vaccination program were major motivating factors in its success.

Laboratory Test Utilization in an Expanding Regional Laboratory Network: Past Successes and Future Opportunities

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Tamera Paczos ◽  
Phoenix Bell
Keyword(s):  
Medical Center ◽  
Laboratory Diagnostics ◽  
Molecular Testing ◽  
Successful Implementation ◽  
Close Monitoring ◽  
Reference Test ◽  
Health Care Environment ◽  
Quality Patient Care ◽  
Outpatient Settings ◽  
The University

Abstract Introduction The University of Rochester Medical Center developed a reference test utilization program implemented in 2011 to tackle increasing test volumes and costs. There was an initial >7,000 decrease in test volumes, which equated to >$1,000,000.00 in savings by year end 2012. Despite this, by the end of 2018, testing volumes had increased 34% and the cost had climbed 36%. Here we would like to discuss the methods implemented for initial success, potential reasons for continued increases in volumes and costs, and ideas to mitigate this trend in the future. Methods In 2010, the University of Rochester formed a laboratory diagnostics committee, which successfully decreased reference testing volumes and costs in both the inpatient and outpatient settings. They did this by developing a formulary for reference tests, which was divided into three tiers based on clinical utility and cost: tier 1 tests, unrestricted and available to all providers to order; tier 2 tests, restricted with only board-certified, subspecialty-trained physicians able to order; and tier 3 tests, off formulary and not available to order. The resident physician staff was also no longer allowed to order any reference testing on inpatients. Despite initial gains costs and volumes have climbed >36% and 34%, respectively, since implementation. Possible explanations for this include the addition of regional affiliate hospitals and reference clients that are not following these protocols, increased testing volumes, and increasing use of molecular testing. Conclusion Despite successful implementation of a reference test utilization program, close monitoring and adaptations are necessary in our continuously changing health care environment to remain effective. Implementation of the program at the regional affiliate hospitals and a more robust molecular testing menu in-house are potential options to control rising costs while providing high-quality patient care.

Mandatory Influenza Vaccination of Healthcare Workers: A 5-Year Study

2010 ◽  
Vol 31 (9) ◽  
pp. 881-888 ◽  
Author(s):  
Robert M. Rakita ◽  
Beverly A. Hagar ◽  
Patricia Crome ◽  
Joyce K. Lammert
Keyword(s):  
Influenza Vaccination ◽  
Healthcare Workers ◽  
Influenza Season ◽  
Medical Center ◽  
Tertiary Care ◽  
Vaccination Program ◽  
First Year ◽  
Vaccination Rates ◽  
Religious Reasons ◽  
To Receive

Background.The rate of influenza vaccination among healthcare workers (HCWs) is low, despite a good rationale and strong recommendations for vaccination from many health organizations.Objective.To increase influenza vaccination rates by instituting the first mandatory influenza vaccination program for HCWs.Design and Setting.A 5-year study (from 2005 to 2010) at Virginia Mason Medical Center, a tertiary care, multispecialty medical center in Seattle, Washington, with approximately 5,000 employees.Methods.All HCWs of the medical center were required to receive influenza vaccination. HCWs who were granted an accommodation for medical or religious reasons were required to wear a mask at work during influenza season. The main outcome measure was rate of influenza vaccination among HCWs.Results.In the first year of the program, there were a total of 4,703 HCWs, of whom 4,588 (97.6%) were vaccinated, and influenza vaccination rates of more than 98% were sustained over the subsequent 4 years of our study. Less than 0.7% of HCWs were granted an accommodation for medical or religious reasons and were required to wear a mask at work during influenza season, and less than 0.2% of HCWs refused vaccination and left Virginia Mason Medical Center.Conclusion.A mandatory influenza vaccination program for HCWs is feasible, results in extremely high vaccination rates, and can be sustained over the course of several years.

scholarly journals Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

2021 ◽  
pp. 1-26
Author(s):  
Akane Takamatsu ◽  
Hitoshi Honda ◽  
Tomoya Kojima ◽  
Kengo Murata ◽  
Hilary Babcock
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
Vaccination Rate ◽  
Multifaceted Intervention ◽  
Vaccine Hesitancy ◽  
Healthcare Personnel ◽  
Tertiary Care Center ◽  
Post Intervention ◽  
Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

scholarly journals Low adherence to pneumococcal vaccination in lung cancer patients in a tertiary care university hospital in Southern Germany

2021 ◽  
Author(s):  
Arno Mohr ◽  
Mia Kloos ◽  
Christian Schulz ◽  
Michael Pfeifer ◽  
Bernd Salzberger ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Medical Records ◽  
Hepatitis A ◽  
Tertiary Care ◽  
Pneumococcal Vaccination ◽  
University Hospital ◽  
Lung Cancer Patients ◽  
Tick Borne Encephalitis ◽  
The University

Abstract IntroductionThe aim of this study was to investigate the adherence to vaccinations, especially pneumococcal vaccinations, in lung cancer patients.MethodsThe study was performed at the University Hospital Regensburg, Germany. All patients with a regular appointment scheduled between December 1, 2020, and April 29, 2021, and who provided informed consent were included. Available medical records, vaccination certificates and a questionnaire were analyzed.Results136 lung cancer patients (NSCLC n = 113, 83.1%, SCLC n = 23, 16.9%) were included. A correct pneumococcal vaccination according to national recommendations was performed in 9.4% (12/127) of patients.A correct vaccination was performed for tetanus in 50.4% (6/131), diphtheria in 34.4% (44/128), poliomyelitis in 25.8% (33/128), tick-borne encephalitis in 40.7% (24/59), hepatitis A in 45.5% (7/11), hepatitis B in 38.5% (5/13), shingles in 3.0% (3/101), measles in 50.0% (3/6), pertussis in 47.7% (62/130), influenza in 54.4% (74/136) and meningococcal meningitis in 0% (0/2).ConclusionAdherence to pneumococcal vaccinations, as well as other vaccinations, is rather low in lung cancer patients.

Use Of A Mobile Cart Influenza Program For Vaccination Of Hospital Employees

2004 ◽  
Vol 25 (11) ◽  
pp. 918-922 ◽  
Author(s):  
Catherine Sartor ◽  
Herve Tissot-Dupont ◽  
Christine Zandotti ◽  
Francoise Martin ◽  
Pierre Roques ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Vaccination Rate ◽  
Associate Professor ◽  
University Hospital ◽  
Vaccination Program ◽  
Vaccination Rates ◽  
Vaccination Acceptance ◽  
The Impact ◽  
Haenszel Test

AbstractObjective:Rates of annual influenza vaccination of healthcare workers (HCWs) remained low in our university hospital. This study was conducted to evaluate the impact of a mobile cart influenza vaccination program on HCW vaccination.Methods:From 2000 to 2002, the employee health service continued its annual influenza vaccination program and the mobile cart program was implemented throughout the institution. This program offered influenza vaccination to all employees directly on the units. Each employee completed a questionnaire. Vaccination rates were analyzed using the Mantel–Haenszel test.Results:The program proposed vaccination to 50% to 56% of the employees. Among the nonvaccinated employees, 52% to 53% agreed to be vaccinated. The compliance with vaccination varied from 61% to 77% among physicians and medical students and from 38% to 55% among nurses and other employees. Vaccination of the chief or associate professor of the unit was associated with a higher vaccination rate of the medical staff (P < .01). Altogether, the vaccination program led to an increase in influenza vaccination among employees from 6% in 1998 and 7% in 1999 before the mobile cart program to 32% in 2000, 35% in 2001, and 32% in 2002 (P < .001).Conclusions:The mobile cart program was associated with a significantly increased vaccination acceptance. Our study was able to identify HCW groups for which the mobile cart was effective and highlight the role of the unit head in its success.

Improving pneumococcal vaccination rates in pediatric acute lymphoblastic leukemia/lymphoblastic lymphoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18666-e18666
Author(s):  
Simone Chang ◽  
Alexandra Cheerva ◽  
Michael Angelo Huang ◽  
Kerry McGowan ◽  
Esther E Knapp ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Hematologic Malignancy ◽  
Lymphoblastic Leukemia ◽  
Pneumococcal Vaccination ◽  
Vaccination Rate ◽  
Lymphoblastic Lymphoma ◽  
Pediatric Acute Lymphoblastic Leukemia ◽  
Vaccination Rates ◽  
Targeted Interventions ◽  
Pediatric All

e18666 Background: Pediatric Acute Lymphoblastic Leukemia/ Lymphoblastic Lymphoma (ALL/LLy) is the most common pediatric cancer. Invasive pneumococcal disease (IPD) is prevalent in this population and the Centers for Disease Control and Prevention recommends pneumococcal vaccination to decrease morbidity and mortality. Despite these recommendations, vaccination rates remain low and the incidence of IPD among children with hematologic malignancy is significantly higher compared to the average pediatric population. An interventional study was designed to improve the vaccination rate and reduce the incidence of IPD in our institution. Methods: A plan-do-study-act (PDSA) model of quality improvement (QI) was used. Chart review at our institute was done for the 6-month period of January 2020 - June 2020 and baseline rates for pneumococcal polysaccharide (PPSV23) vaccination were calculated. Patients were included if they were ≥ 2 years old, diagnosed with ALL/LLy, and undergoing maintenance. A multidisciplinary team performed the root cause analysis. Immunization records were obtained and reviewed and targeted interventions were implemented. The interventions used are outlined in Table. The percentage of pediatric ALL/LLy patients per month in maintenance who received age-appropriate pneumococcal vaccinations was monitored before and after the interventions. Results: Analysis of the 6-month retrospective cohort (n=36) showed a baseline vaccination rate of 5.5%. During the subsequent 6-month phase with interventions, 40 patients were prospectively enrolled. Demographics showed a mean age of 10.2 years (range, 2-21) and a predominantly male (66.7%) cohort. B-cell ALL/LLy comprised the majority (78.9%); the rest included T-cell ALL/LLy and mixed phenotype acute leukemia. As seen in Table, the percentage receiving at least 1 pneumococcal vaccine increased from 5.5% to 84.8% over the first 3 months, this plateaued around 81%. Completion of the series mirrored this and increased to 74.2%. Pre-visit planning and cues proved to be the most helpful interventions. Conclusions: Use of a PDSA model successfully improved pneumococcal vaccination rates in the pediatric ALL/LLy population. We suggest these results can be achieved with planning and implementation of the outlined interventions. [Table: see text]

A TEACHING PROGRAM IN COMMUNITY PEDIATRICS

PEDIATRICS ◽  
1960 ◽  
Vol 25 (2) ◽  
pp. 336-339
Author(s):  
Kenneth D. Rogers
Keyword(s):  
Medical Center ◽  
Group Discussion ◽  
Outpatient Service ◽  
Field Trip ◽  
Teaching Program ◽  
Exceptional Children ◽  
University Of Pittsburgh ◽  
School Of Medicine ◽  
Informal Discussion ◽  
The University

AT THE School of Medicine of the University of Pittsburgh, the Department of Pediatrics has organized a series of field experiences intended to acquaint future physicians with programs and facilities outside the confines of the Medical Center which are concerned directly or indirectly with the health and welfare of normal and exceptional children. During their pediatric outpatient service, senior medical students in groups of six to eight spend 6 half-days in "community pediatric" training. Each student is loaned a collection of selected reprints, booklets and mimeographed material pertinent to the areas covered in the community experiences. They are urged to read the appropriate material before each field trip in order that their observations may be meaningful and productive. Additional preparation is given at the visit site by approximately an hour's group discussion of the general area to be covered, specific items to be noted, and questions to be considered during the experience. No attempt is made to cover all aspects of the program being viewed. Informal discussion and interpretation are maintained by the instructor throughout the field trip.

Implementation of the Acute Care Nurse Practitioner Role

1994 ◽  
Vol 5 (3) ◽  
pp. 404-407
Author(s):  
Lynn A. Kelso ◽  
Lori M. Massaro
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Center ◽  
Care Nurse ◽  
University Of Pittsburgh ◽  
Acute Care Nurse Practitioner ◽  
The University ◽  
Pittsburgh Medical ◽  
Practitioner Role

In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center arc described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.

Short-Term Results of Treating Primary and Recurrent Anal Fistulas with a Novel Extracellular Matrix Derived from Porcine Urinary Bladder

2015 ◽  
Vol 81 (5) ◽  
pp. 498-502 ◽  
Author(s):  
Tara Iorio ◽  
David Blumberg
Keyword(s):  
Urinary Bladder ◽  
Medical Center ◽  
Experimental Studies ◽  
Great Promise ◽  
Anal Fistulas ◽  
Short Term ◽  
University Of Pittsburgh ◽  
Standardized Protocol ◽  
Promising Treatment ◽  
The University

Anal fistulas are difficult to treat because they are often recalcitrant to medical therapies and surgical treatment may lead to significant morbidities. A recent novel biologically derived graft from porcine urinary bladder (MatriStem™) has shown great promise in experimental studies of tissue regeneration in diverse tissues. The objectives of this study were to evaluate the safety and short-term efficacy of MatriStem for treatment of anal fistulas. This was a retrospective study of patients treated from January 3, 2012 to March 3, 2014 at the University of Pittsburgh Medical Center. MatriStem was used to treat patients with anal fistulas by implanting it uniformly with a single application in all patients using a standardized protocol. Data were collected retrospectively from hospital records and office charts. Nineteen fistulas were treated with MatriStem. There were no adverse complications. Overall efficacy of MatriStem was 79 per cent with healing occurring in a mean time of 17 days and mean follow-up of seven months (range 1–26 months). MatriStem was effective in healing in 75 per cent of primary anal fistulas and 86 per cent of recurrent fistulas. MatriStem seems to be a safe and promising treatment for primary and recurrent anal fistulas, and warrants further study and clinical trials to substantiate widespread clinical use.

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