Standing Orders for Vaccinations

To help MGH achieve the target of 95% patient vaccination rate, standing orders for vaccinations to prevent pneumococcal infections and seasonal influenza are placed automatically on eligible patients. Each patient will be assessed for eligibility automatically, on addition to the inpatient census. Eligibility is based on the age and vaccination history of the patient. When a patient is eligible for one or both vaccines, the order is placed automatically as soon as any existing pre-admission orders have been activated.

Key features:

• Automatic evaluation of the vaccination status for pneumococcus of all inpatients over the age of 65

• Automatic evaluation of patient for risk of pneumococcal infection based on diagnosis

• Automatic evaluation of the vaccination status for influenza of all inpatients in the annually-defined age group, during flu season for that year (usually early fall through late spring), when vaccine is available

• The patient's records are checked for previous vaccinations

• The automatic order is NOT placed if the patient has a recorded allergy to the vaccination

• Orders are not placed for patients in surgery (PACU or SDSU)

• Orders are not placed for patients in the ED observation area

• A banner on the Orders for This Session list (main scratchpad) indicates when a vaccination order has been placed on the patient, and is visible until 12 hours after the order is RN reviewed

• The order(s) are signed “Standing order approved by MGH Medical Policy Committee”

• If you discontinue a standing vaccination order, you are prompted to select a reason for doing so.

• If the selected reason for discontinuing a standing vaccination order is that the patient is allergic to the vaccine, you are prompted to select the allergic reaction(s), then to sign, which adds the allergy directly to the patient's record in PEAR (Partners Enterprise Allergy Repository).

Instructions:

• Viewing Orders

• Recording Allergies, Restrictions, and Adverse Reactions

• Discontinuing Orders

Discharge Requires Documentation of Vaccinations—When a patient has one or more orders for required vaccinations that have not been documented in the eMAR (electronic Medication Administration Record), an RN must document the vaccination(s) as given or not given, as applicable, before discharge documentation can be printed. Discharge orders and instructions can be entered and saved; only printing is restricted.

Recording the Administration of the Vaccine: Nurses document the administration of vaccinations in the eMAR. For procedures and additional information, see:

• Documenting Administrations in the eMAR

• UCM eMAR Cues

• Generating Reports in the eMAR

Prompting for Pediatric Second Dose Vaccinations—To achieve satisfactory antibody response, children younger than 9 years who were not vaccinated in a previous flu season, and who have so far received only 1 dose of vaccine during the current season, should receive a second dose no sooner than 4 weeks after the first dose. When an MD, NP, PA, or CNM selects a pediatric patient under 9 years old and starts to write orders, the patient's records are reviewed automatically to determine is a second vaccination is needed. If the booster is indicated, the ordering provider is prompted to write the order. The provider can also defer the decision. The prompt appears until the order has been written, or a reason for not ordering the booster has been selected. See Responding to the Prompt to Order a Pediatric Vaccination Booster.