Dont Hesitate, Vaccinate Inpatient Pneumococcal Vaccine

1
Dont Hesitate, VaccinateInpatient Pneumococcal
Vaccine

• Joseph A. Sopko, MD
• Director Pulmonary Medicine, Critical Care
• St. Vincent Charity Hospital
• Ohio KePRO Consultant
• Tammera Caine, BA, MS
• Project Leader
• Acute Care Services

2
Welcome

• Participant lines are listen only until the Q A
  period at the end of the presentation
• The teleconference coordinator will give
  instructions for participants to ask questions
• If you are disconnected, please call
  I-800-362-0574 and ask to be reconnected
• Power Point Slides are available on Ohio KePROs
  web site

3
Objectives of the Teleconference

• Describe process measurement for pneumococcal
  vaccine and identification of exclusions.
• Explain the clinical performance of pneumococcal
  vaccine. Why is it so good?
• Identify barriers that contribute to the low
  vaccination rates and tools for success .

4
Process Measurement

• Pneumococcal Vaccination
• Numerator Statement Patients with pneumonia,
  age 65 and older, who were screened for
  pneumococcal vaccine status and were vaccinated
  prior to discharge, if indicated.

5
Process Measurement

• Denominator Statement All pneumonia patients
  age 65 and older.
• Included Populations - Medicare discharges with
• A principal ICD-9-CM diagnosis of pneumonia OR
• A principal diagnosis of septicemia, or
  respiratory failure (acute or chronic) AND a
  secondary diagnosis of pneumonia
• Patients who were age 65 years and older
• Excluded Populations
• Patients who were transferred from another acute
  care or critical access hospital
• Patients who had no working diagnosis of
  pneumonia at the time of admission
• Patients who received comfort measures only
• Patients who expired in the hospital
• Patients who left the hospital AMA
• Patients who were discharged to hospice care
• Patients who were transferred to another short
  term general hospital for inpatient care

6
Pneumonia Vaccine CMS Quality Measures
7
Morbidity and Mortality

• S. pneumoniae infection accounts for
• At least 500,000 cases of pneumonia
• 50,000 cases of bacteremia, and
• 125,000 hospitalizations each year
• More people die from pneumococcal infections
  (40,000) than from any other vaccine preventable
  diseases
• Approximately half of these deaths could be
  prevented by use of the vaccine

8
Vaccine Preventable Diseases

• 5th leading cause of death in the United States
  for patients aged 65 years and older
• gt 90 of deaths occur in those aged 65 years or
  older
• Considerable morbidity, hospitalization, and costs

9
Missed Opportunities
Percentage of Adults Age 65 Who Received
Pneumococcal and Vaccine
National Health Interview Survey 2001
10
Missed Opportunities

• Two-thirds of people who died from serious
  pneumococcal infection had been hospitalized in
  the previous 3-5 years

11
Vaccination Reality

• Despite the fact that pneumococcal vaccine is
• clinically effective
• cost effective
• safe, and
• free to most elderly patients

Pneumococcal Vaccine is under-utilized!
12
Antibiotic Resistance

• Perhaps some feel that we should not worry about
  a disease so easily controlled by antibiotics.
  Unfortunately, the prevalence of multiple
  antibiotic resistant strains is up to 35 in some
  cases.
• Across the country
• 60 of pneumococci susceptible to penicillin
• 20 are intermediately resistant
• 20 are completely resistant

13
Who Should Receive the Pneumococcal Vaccine?

• All immunocompromised persons aged gt 2 years
• All persons gt 65 years of age
• Persons aged 2-64 years with
• Cardiovascular or pulmonary disease
• Diabetes mellitus
• Kidney disease
• Alcoholism, chronic liver disease
• Cerebrospinal fluid leaks
• Functional or anatomic asplenia
• Or living in special environments or social
  settings

Centers for Disease Control and Prevention.
Prevention of Pneumococcal Disease
Recommendations of the Advisory Committee on
Immunization Practices. MMWR. 199746 (No.
RR-8) 10-12.
14
Contraindications

• Contraindications should be assessed prior to
  vaccination
• Few patients have true contraindications

15
New Federal Regulation by CMS to Improve Adult
Immunization Rates

• the final rule will remove the Federal barrier
  related to the requirement for a physician to
  order influenza and pneumococcal immunizations in
  Medicare and Medicaid participating hospitals,
  long-term care facilities, and home health
  agencies
• - Federal Register/Volume 67 No. 191, October 2,
  2002

16
Why a Change in Regulation?

• Increase adult immunization
• Decrease vaccine-preventable disease and death
• Simplification of the immunization process
• Standing orders programs are effective

17
Standing Orders Programs

• Standing orders programs authorize nurses or
  pharmacists, where allowed by state law, to
  administer vaccinations according to an
  institution- or physician-approved protocol
  without the need for a physicians order or
  signature.

MMWR. 2000 49 (No. RR-1) 15-26
18
Standing Orders Program Components

• Procedures to identify eligible patients
• Procedures to provide information on the risks
  and benefits
• Proper recording of refusals or contraindications
• Approved vaccine delivery protocol
• Quality assurance and documentation procedures

19
Standing Orders ProgramService Delivery
Components
CDC. MMWR. 200251 (No. RR-3)1-36.
20
Barriers Contributing toLow Vaccination Rates

• Unknown patient vaccination status
• Physician reimbursement
• Patient health status at time of hospitalization

21
Ideas for Testing Changes

• Standing orders for vaccine administration
• Standardized protocol for assessing vaccination
  status of all eligible patients
• Add vaccination screening questions to nursing
  assessment form or discharge instructions
• Visible reminders or checklists
• Educate staff on importance of vaccinating high
  risk populations at any opportunity

22
Ideas for Testing Changes

• Make PNE high risk population list available for
  clinical staff year round
• Physician champion meets 1-on-1, and at business
  meetings
• Per authority of Medical Executive policy
• Admitting order check box to assess and immunize

23
A vaccine not given is 100 ineffective!
- Dale W. Bratzler, DO, MPH Principal Clinical
Coordinator, National Pneumonia Project Oklahoma
Foundation for Medical Quality
24
Questions
25
Continuing Education Credits

• To get your free nursing CE credits
• Stay on line for the entire call
• Complete the evaluation document on paper or on
  line
• On line at http//www.ohiokepro.com/vaceval.asp
• Fax at 216-654-1510
• Complete evaluation within 30 days of the
  telephone conference

26
Contact Us

• Call us toll free on the Ohio KePRO QIC Line
• 1-800-385-5080
• Or e-mail us at
• Hospital_at_ohqio.sdps.org