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Nurse-Driven Electronic Pneumococcal Assessment Protocols Increase Vaccination Rates In Geriatric Population

Nurse-Driven Electronic Pneumococcal Assessment Protocols Increase Vaccination Rates In Geriatric Population. Gwynne Decker, RN Sue Ellen Grego, RN Michele Jennings, RN. Objectives. Describe how Streptococcus pneumococcus effects geriatric population

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Nurse-Driven Electronic Pneumococcal Assessment Protocols Increase Vaccination Rates In Geriatric Population

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  1. Nurse-Driven Electronic Pneumococcal Assessment Protocols Increase Vaccination Rates In Geriatric Population Gwynne Decker, RN Sue Ellen Grego, RN Michele Jennings, RN

  2. Objectives Describe how Streptococcus pneumococcus effects geriatric population Identify nursing interventions that reduce complications related to pneumococcal disease Describe an electronic pneumococcal vaccine assessment tool utilized by nurses at Hershey Medical Center

  3. Objectives Describe the computer systems needed to implement the electronic protocol Describe the technology-related competencies needed by the professional nurse working with the electronic protocol Describe the informatics nurse's role in the development and implementation of the electronic protocol

  4. Geriatric Population Most Directly Effected By Pneumococcal Disease In 2004, Streptococcus pneumonia or pneumoccocus caused 40,000 deaths in patients aged 65 years and older (Kishel, Maguire, Pankrantz, & Julian, 2009) Pneumococcal disease is the 8th leading cause of death in the geriatric population when combined with influenza (Kishel, et.al, 2009) Pneumococcal disease is avoidable with administration of the pneumovax vaccine Nursing interventions are necessary for increased pneumococcal vaccine administration in the geriatric population

  5. Can a Nurse-Driven Electronic Protocol Intervention Solve the Problem? Research shows low pneumococcal vaccination rates in hospitalized patients with missed opportunities for immunization when there was no implementation of an electronic protocol (Jones, et.al, 2008; Kishel, et.al, 2009; Scheurer, Cawley, Brown & Heffner, 2006) Several studies suggest electronic protocols significantly increase pneumococcal vaccine administration in patients aged 65 years and older (Jones, et.al, 2008; Scheurer, et.al, 2006; Sokos, Skledar, Ervin, Nowalk, Zimmerman, Fox & Middleton, 2007) Increased vaccination rates will lead to decreased pneumococcal disease and lower patient illness, hospital admission, and patient death

  6. Significant Increases In Vaccination RatesAfter Implementation Of Electronic Protocols UPMC: University of Pittsburgh Medical Center MUSC: The Medical University of South Carolina Denver: Denver Health & Hospitality Authority Primary Care services (Jones, et.al, 2008; Scheurer, et.al, 2006; Sokos, et.al, 2007)

  7. Electronic Protocol Tool Development • In 2002 Centers for Medicare and Medicaid Services mandated all patients be assessed upon admission to hospitals for eligibility to receive the pneumococcal vaccine (Jones, Hammer, Swenson, Appel, Phibbs, Hill & Kennedy, 2008) • To meet regulations a multidisciplinary team was formed (Kishel, et.al, 2009) • Disciplinary team also developed protocol and searched for software to assist in implementation (Kishel, et.al, 2009)

  8. Computer System Software • The electronic protocol software needed to interface with the existing Electronic Medical Record (EMR) (M.S. Hamilton, personal communication, November 23, 2009) • Protocol software was created using a Computerized Physician Order Entry System (CPOE) (Hamilton, 2009) • Both EMR and CPOE were developed using Cerner Corporation’s PowerChart and Connect Programs (Cerner Corporation, 2009)

  9. Electronic Pneumococcal Assessment Tool (Kishel, et.al, 2009)

  10. The Informatics Nurses Role In The Development and Implementation Of The Electronic Protocol • Liaison between nurses and other departments to ensure nurses ideas and concerns are addressed during designing of the software • Addresses the educational needs of the staff for the hardware and software of the computer before and after implementation of the protocol • Troubleshoots problems that occur during designing, implementation, and use of the protocol • Promotes a positive attitude at all times during transition to electronic protocols and assists staff in maintaining positive attitudes

  11. Implementation Of ProtocolCompleted By Nursing Staff • Assessment was completed by checking patient age, vaccination history, allergies, ICU status, and contraindications including organ transplant, bone marrow transplant, chemotherapy or CVA patient • After assessment, if indicated, the tool would create an electronic order for a pneumococcal vaccine into the electronic medication administration record of the patient • Physicians have a 24 hour window to discontinue the vaccination if there is a medical reason for removal of order • Pharmacy can review billing records to determine if any prior inpatient immunizations had occurred, at which time the pharmacist could cancel the order and notify nursing • Task in computer documentation would automatically be set up for nursing which required documentation of vaccine manufacturer, lot number, expiration, administration date, and site of administration •  (Kishel, et.al, 2009)

  12. The Working Team Nurses need to be confident in navigating the computer and applications for the electronic protocol and vaccination program to be successful

  13. Ethical/Legal Concerns WithElectronic Pneumococcal Protocol Concerns may arise if the following occur: • Patient is cognitively unable to give informed consent for vaccine administration • Patient is unable to communicate with healthcare staff due to language barrier

  14. Summary • Streptococcus pneumococcus mostly affects geriatric population • Nursing assessment reduces complications related to pneumococcal disease • A nurse driven electronic pneumococcal vaccine assessment tool has demonstrated an increase in pneumococcal vaccine rates in hospitalized patients aged 65 years and older • Nurses specializing in informatics provide a valuable resource in the development of computer systems and electronic protocols • Nurses need to stay knowledgeable about technology-related competencies such as those utilized with electronic protocols

  15. References Cerner Corporation. (2009). The Complete Electronic Patient Record PowerChart. Retrieved December 7, 2009, from www.cerner.com/public/Cerner_3.asp?id=29757&cite=uk Jones, K., Hammer, A., Swenson, C., Appel, A. Phibbs, S., Hill, F. & Kennedy, O. (2008).     Improving adult immunization rates in primary care clinics. Nursing Economic$, 26(6),     404-407. Kishel, J., Maguire, M., Pankrantz, L. & Julian, K. (2009). Implementing an electronically based,     nurse-driven pneumococcal vaccination protocol for inpatients. American Journal of     Health-System Pharmacists, 66, 1304-1308. doi:10.2146/080147 Scheurer, D., Cawley, P., Brown, S. & Heffner, E. (2006). Overcoming barriers to pneumococcal     vaccination in patients with pneumonia. American Journal of Medical Quality, 18(21),     18-29. doi:10.1177/1062860605280314 Sokos, D. Skledar, S., Ervin, K., Nowalk, M.P., Zimmerman, R., Fox, D. & Middleton, D. (2007). Designing and implementing a hospital-based vaccine standing orders program. American Journal of Health-System Pharmacists, 64. doi:10.2146/ajhp060321

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