Skip to main content Accessibility help

Improving the Rates of Inpatient Pneumococcal Vaccination: Impact of Standing Orders Versus Computerized Reminders to Physicians

  • Christina M. Coyle (a1) (a2) and Brian P. Currie (a1) (a3)



To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group.


Open trial of the following approaches, each on a different ward: (1) standing orders for vaccination of eligible consenting patients, (2) computerized reminders to physicians, and (3) usual practice.

Setting And Patients:

Four hundred twenty-four patients were admitted to three 30-bed inpatient medical wards during a 4-month period in 1999 at one hospital. Unvaccinated patients 65 years or older and competent to give oral consent were included.


A pharmacist activated a standing orders protocol for vaccination of all eligible consenting patients on one ward and computerized reminders to physicians on a second ward. A third ward served as a control group.


Forty-two patients met inclusion criteria and accepted vaccination in the standing orders arm versus 35 patients in the computerized reminder arm. Vaccination rates on the standing orders ward included 98% of those eligible and accepting vaccination, 73% of eligible patients, and 28% of all patients admitted. Rates on the computerized reminder ward were 23%, 15%, and 7%, respectively. All of the rates from the standing orders ward were significantly greater than those from the computerized reminder ward (P < .0001). Only 0.6% of all patients on the control arm were vaccinated.


Although both interventions were effective in increasing inpatient pneumococcal vaccination rates relative to baseline practice, physician independent initiation of standing orders was clearly more effective.


Corresponding author

Division of Infectious Diseases, Department of Medicine, Jacobi Medical Center, Room 3 NY, 1400 Pelham Parkway South and Eastchester Road, Bronx, NY 10461


Hide All
1. Hofmann, J, Cetron, MS, Farley, MM, et al. The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. N Engl J Med 1995;333:481486.
2. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997;46(RR-8):124.
3. Istre, GR, Tarpay, M, Anderson, M, Pryor, A, Welch, D. Invasive disease due to Streptococcus pneumoniae in an area with a high rate of relative penicillin resistance. J Infect Dis 1987;156:732735.
4. Breiman, RF, Spika, JS, Navarro, VJ, Darden, PM, Darby, CP. Pneumococcal bacteremia in Charleston County, South Carolina: a decade later. Arch Intern Med 1990;150:14011405.
5. Bennett, NM, Buffington, J, LaForce, FM. Pneumococcal bacteremia in Monroe County, New York. Am J Public Health 1992;82:15131516.
6. Butler, JC, Breiman, RF, Lipman, HB, Hofmann, J, Facklam, RR. Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978-1994: implications for development of a conjugate vaccine. J Infect Dis 1995;171:885889.
7. Shapiro, ED, Clemens, JC. A controlled evaluation of the protective efficacy of pneumococcal polysaccharide vaccines. JAMA 1977;238:26132616.
8. Sims, RV, Steinmann, WC, McConville, JH, King, LR, Zwick, WC, Schwartz, JS. The clinical effectiveness of pneumococcal vaccine in the elderly. Ann Intern Med 1988;108:653657.
9. Shapiro, ED, Berg, AT, Austrian, R, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991;325:14531460.
10. Farr, BM, Johnston, BL, Cobb, DK, et al. Preventing pneumococcal bacteremia in patients at risk: results of a matched case-control study. Arch Intern Med 1995;155:23362340.
11. Fedson, DS, Houck, P, Bratzler, D. Hospital-based influenza and pneumococcal vaccination: Sutton's Law applied to prevention. Infect Control Hosp Epidemiol 2000;21:692699.
12. Surveillance for vaccination coverage among children and adults: United States. MMWR 2000;49:162.
13. Klein, RS, Adachi, N. Pneumococcal vaccine in the hospital: improved use and implication for high-risk patients. Arch Intern Med 1983:143:18781881.
14. Fedson, DS, Harward, MP, Reid, RA, Kaiser, DL. Hospital-based pneumococcal immunization: epidemiologic rationale from the Shenandoah study. JAMA 1990;264:11171122.
15. Klein, RS, Adachi, N. An effective hospital-based pneumococcal immunization program. Arch Intern Med 1986;146:327329.
16. Clancy, CM, Gelfman, D, Poses, RM. A strategy to improve the utilization of pneumococcal vaccine. J Gen Intern Med 1992;7:1418.
17. Bloom, HG, Bloom, JS, Krasnoff, L, Frank, AD. Increased utilization of influenza and pneumococcal vaccines in an elderly hospitalized population. J Am Geriatr Soc 1988;36:897901.
18. Overhage, JM, Tierney, WM, McDonald, CJ. Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med 1996;156:15511556.
19. Vondracek, TG, Pham, TP, Huycke, MM. A hospital-based pharmacy intervention program for pneumococcal vaccination. Arch Intern Med 1998;158:15431547.
20. Rhew, DC, Glassman, PA, Goetz, MB. Improving pneumococcal vaccine rates: nurse protocols versus clinical reminders. J Gen Intern Med 1999;14:351356.
21. Morton, MR, Spruill, WJ, Cooper, JW. Pharmacist impact on pneumococcal vaccination rates in long term care facilities. Am J Hosp Pharm 1988;45:73.
22. Dexter, PR, Perkins, S, Overhage, JM, Maharry, K, Kohler, RB, McDonald, CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001:345:965970.
23. Metersky, ML, Fine, JM, Tu, GS, et al. Lack of effect of a pneumonia clinical pathway on hospital-based pneumococcal vaccination rates. Am J Med 2001;110:141143.
24. Robke, JT, Woods, M, Heitz, S. Pharmacist impact on pneumococcal vaccination rates through incorporation of immunization assessment into critical pathways in an acute care setting. Hospital Pharmacy 2002;37:10501054.
25. Keely, JL. Pharmacist scope of practice. Ann Intern Med 2002;136:7985.
26. Woods, M, Robke, JT. Removing hospitalization as a barrier to immunization. Clin Infect Dis 2003;36:673674.


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed