Biomedical subjects

Donald B Middleton

Publications and source records attributed to Donald B Middleton.

9 recordsLinked to original sources

PubMed2005

Overcoming barriers to establishing an inpatient vaccination program for pneumococcus using standing orders.

OBJECTIVES: 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.

Aged↗

PubMed2005

Vaccines for persons at high risk due to medical conditions, occupation, environment, or lifestyle, 2005.

The rates of morbidity and mortality due to influenza and pneumococcal diseases are high among persons with underlying medical conditions; thus, influenza and pneumococcal polysaccharide vaccines are recommended for those with cardiac disease, diabetes mellitus, chronic obstructive pulmonary disease, and other chronic illnesses. For the same reasons, influenza vaccine is recommended for pregnant women and for persons with asthma. Health care workers are at high risk for acquiring and transmitting hepatitis B, measles, varicella, and influenza; hence, vaccination against these diseases is recommended.

Bacterial Vaccines↗

PubMed2005

Vaccine schedules and procedures.

This article presents the 2005 Recommended Childhood and Adolescent Immunization Schedule; the catch-up schedule; the 2004-2005 Recommended Adult Immunization Schedule, which will stay in effect for 2005; contraindications for immunization; and general guidelines on immunization procedures. Recent changes for children include institution of thimerosal-free hepatitis B vaccination either before hospital discharge or as soon after birth as possible and the recommendation to give inactivated influenza vaccine to all children who will be between the ages of 6 and 23 months during the influenza season. Minimal intervals between vaccines and vaccine precautions, contraindications, administration, and storage are reviewed. Sources of vaccine information are presented and discussed.

Adolescent↗

PubMed2005

Routine vaccines across the life span, 2005.

Routine vaccines include those listed on the Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule. The disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations are discussed in relation to each vaccine. Pictures of vaccine-preventable diseases are included.

Age Factors↗

PubMed2003

Increasing pneumococcal vaccination rates among hospitalized patients.

OBJECTIVE: To increase the proportion of inpatients vaccinated against pneumococcal infection. DESIGN: Pre- and post-intervention study. SETTING: University medical center-affiliated, suburban community teaching hospital. PATIENTS: Unvaccinated inpatients 65 years and older and those 2 to 64 years old who had chronic medical conditions predisposing them to invasive pneumococcal infection. INTERVENTION: The nursing staff screened newly admitted patients for eligibility based on age, diagnosis, or medications from a computer-generated admissions list and placed a pre-printed order form for the pneumococcal polysaccharide vaccine (PPV) on the charts of eligible patients. Following the physician's order, the nursing staff administered the PPV and recorded it Ongoing quality improvements including admission vaccination screening and computer-based record keeping were initiated to identify unvaccinated eligible patients and track vaccination status. RESULTS: Efforts resulted in rates of in-hospital vaccination ranging from 3.1% to 7.9% (mean, 5.2% +/- 1.7% [standard deviation]) and significant improvements in the assessment of previous vaccination status, reaching 54% of eligible patients after 1 year. Ascertainment of a previous vaccination increased significantly following the initiation of the use of admission forms that specifically assessed vaccination status and a system to permanently record vaccination status in an electronic medical record (P < .05). CONCLUSION: Concerted efforts using electronic medical records significantly improved the assessment and documentation of inpatient vaccination status. Greater improvement of the rates of in-hospital vaccination will require healthcare system-wide efforts such as a standing order policy for vaccinating all eligible patients. Standing orders for inpatient immunization supported by effective assessment and tracking systems have the potential to raise vaccination rates to the goals of Healthy People 2010.

Adolescent↗

PubMed2003

Routine vaccines across the life span, 2003.

This review of the recommendations for routine vaccines includes those used on the Recommended Childhood Immunization Schedule and the Recommended Adult Immunization Schedule. The rationale is provided for recent changes, such as encouraging influenza vaccination of healthy children aged 6 through 23 months and recommending that annual influenza vaccination begin at age 50. The risks and benefits of vaccination are discussed, including disease burden, rationale for vaccination, efficacy, adverse reactions, and recommendations. Pictures of vaccine-preventable diseases are included.

Adult↗

PubMed2003

Vaccines for persons at high risk due to medical conditions, occupation, environment, or lifestyle, 2003.

The safety and efficacy of current vaccines are reviewed for high-risk populations, such as those with underlying medical conditions or occupational or lifestyle circumstances. The morbidity and mortality from vaccine-preventable diseases are high among persons with underlying medical conditions; thus, influenza and pneumococcal polysaccharide vaccines are recommended for those with cardiac disease, diabetes mellitus, or chronic obstructive pulmonary disease. For the same reasons, influenza vaccine is recommended for pregnant women and for persons with asthma. Health-care workers are at risk for acquiring and transmitting hepatitis B, measles, and influenza; hence, vaccination against these diseases is recommended.

Adult↗

PubMed2003

Vaccine schedules and procedures, 2003.

Recent, rapid changes in recommendations regarding vaccination represent challenges for busy clinicians who need to be familiar with new developments. This article reviews the current age-based recommendations that are fundamental to the United States vaccine program, as well as current recommendations regarding contraindications, precautions, administration techniques, and storage procedures for routinely administered vaccines. The 2003 Recommended Childhood Immunization Schedule, the 2002-2003 Recommended Adult Immunization Schedule, contraindications for immunization, and general guidelines on immunization procedures are presented. Recent changes in recommendations for children are instituting thimerosal-free hepatitis B vaccine as soon after birth as possible (before hospital discharge) and encouraging immunization of all children aged 6 to 23 months against influenza.

Adult↗

PubMedDate not supplied

Immunization education among family practice residency programs.

BACKGROUND AND OBJECTIVES: The dynamic nature of immunization schedules, shortages, and administration techniques makes keeping up to date with current national recommendations difficult and necessitates periodic evaluation of immunization teaching resources. METHODS: This study surveyed family practice residency program directors in 1998 to assess their satisfaction with immunization teaching resources and interest in new resources. Subsequently, with funding from the Centers for Disease Control and Prevention, the Society of Teachers of Family Medicine Group on Immunization Education developed a series of educational materials devoted to educating family physicians about immunizations. In 2001, residency directors were surveyed again to evaluate the educational resources. RESULTS: Most program directors reported satisfaction with resources currently available to them for teaching residents about childhood immunizations, but about half (41% in 1998 versus 55% in 2001) agreed that keeping up to date on childhood immunizations was difficult. The corresponding figures for adult immunizations were 27% in 1998 and 36% in 2001. Pocket-size immunization schedules were ranked highly important (53% in 1998 versus 45% in 2001). Many would use handheld computer immunization schedules (53%). Although satisfaction with available resources did not increase following introduction of a newly developed journal supplement and Web site, the limited response received was favorable. CONCLUSIONS: Immunization teaching materials developed by family physicians, especially those that make use of evolving technologies, can be useful resources for individuals teaching family practice residents and for keeping up to date on recommendations for immunizations.

Family Practice↗