A decade of experience with an inpatient pneumococcal vaccination program.

PURPOSE: A hospital's experience with an inpatient pneumococcal vaccination program is described. SUMMARY: Saint Luke's Hospital (SLH) is a 625-bed, tertiary care, referral hospital in Kansas City, Missouri. In a retrospective analysis conducted in 1995 of pneumococcal vaccination rates in patients with community-acquired pneumonia (CAP) at the hospital, only 1 of 84 patients had documented pneumococcal vaccination. These results led to efforts to improve assessment of vaccination status, documentation of vaccination, and pneumococcal vaccination rates. In 1998, the pharmacy department at SLH conducted a study to examine the impact of pharmacists on pneumococcal vaccination rates through incorporation of vaccination assessment into selected critical pathways. Pharmacists were assigned to screen and educate patients on chosen pathways. When eligible patients were identified in the intervention group, the pharmacist would then contact their physician for authorization to vaccinate. The success of the study led to several notable changes to the pneumococcal vaccination program in 2001. First, the vaccination assessment was moved from selected critical pathways to the admission database of all patients. Second, a collaborative practice agreement was developed to authorize pharmacists to write pneumococcal and influenza vaccine orders for eligible patients per the program's protocol. These two changes led to a dramatic improvement in overall screening and documentation rates of pneumococcal vaccination for patients with CAP and for other at-risk patients. CONCLUSION: A pneumococcal vaccination program helped a hospital meet regulatory expectations for vaccination of patients with CAP and vaccinated many other at-risk patients.

Extra help required by litigants after simple fractures--a questionnaire based study.

A questionnaire based interview of 100 patients under fracture clinic review was undertaken to assess the help required with the activities of daily living (ADL) in the first 2 weeks following fractures of the hand, wrist, neck of humerus, foot or ankle. The amount of help patients required was correlated with whether or not the patients were claiming compensation for their injuries. Twenty-five percent were litigating and this was shown to influence the amount of help a patient reported having received with dressing, shopping, cooking, housework, personal hygiene and travelling (p<0.0001) and feeding (p<0.0022), but not with getting in/out of bed (p=0.52). Complications of the fracture were not shown to increase litigation. On average litigants required over 3 h extra help per day compared with non-litigants (6.4 h versus 2.75 h).