the employee influenza vaccine program at the children’s hospital of philadelphia mary g. cooney,...
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The Employee Influenza Vaccine Program at
The Children’s Hospital of Philadelphia
Mary G. Cooney, RN, BSN, COHN-SKeith H. St. John, MT(ASCP), MS, CIC
CHOP Structure420 bed pediatric teaching hospital
• Level 4 NICU, PICU, CICU, oncology & BMT
Extensive out-patient Center
Ambulatory Network ~ 1 million outpatients/year» Primary Care» Specialty Care» Surgical Centers» Kids First Physician Practices
PROGRAM GOALS
Globally…
• Increase the number of patient care
providers receiving annual influenza
vaccine
• Change the culture of accountability
PROGRAM GOALS
Specifically
• Vaccinate 80% of patient care
providers in each individual clinical site
and clinical group within the network
• Achieve 100% participation in the program
What your staff really thinks…
***CDC high alert***
The CDC reports there will be no flu this year. Please cease any preparation your hospital is currently involved in and offer all staff involved in your local influenza program paid time off.
PARTICIPATION DEFINED
All eligible employees identified as having
patient contact required to:
• Receive an influenza vaccine or
• Complete a declination form
CHOP Participants
• 4225 Employees Main Campus
Hospital - Out-patient clinic – RehabSatellite Sites
» Specialty Care »Primary Care »Physician Practices
• 735 Surgical and Anesthesia Affiliates
KEY PROGRAM ELEMENTS
• ASSESSMENT OF PREVIOUS SEASON
• PLANNING
• PROGRAM DESIGN
• IMPLEMENTATION
• TRACKING PROGRESS/REPORTS
• OUTCOME ASSESSMENT
Assessing the previous season
• What were our outcomes?
• Did we achieve our goals?
• What were our successes?
• What challenges remain?
• Who did What Well?
• Did we achieve “herd” immunity?
Planning
Key Elements Getting started:• Engaged support from the very top of the organization• Employee flu vaccine program identified as a Patient Safety goal• Budget developed and approved• Identify key players and responsibilities
Someone has to own the program (OH, IPC)
START EARLY!
Planning
• Multidisciplinary committee meets in the planning and evaluation phases
• Includes managers and front line care providers
• We asked for advice on how to communicate with nursing
• Smaller working team/committee
Program Design
Focus:
• Include employees with patient contact
• Establish and refine tracking mechanisms
• Commit to communicating progress on a regular schedule
• Have a defined, clear message
Get Your Vaccine: Lead by Example Logo
Program Design
Communicating our message
• Public Relations
flu posters
cling ads
CHOP intranet
OHD website
Program Design
• Flu captains and teams
*** leadership and team work key***
• Hold managers accountable
• Kickoff weeks – only goal is vaccinate, vaccinate, vaccinate
• Set up methods for data entry and reports
Screening Form
• TRIVALENT INACTIVATED INFLUENZA VACCINE (INJECTABLE)
• 2008-2009 CHOP OCCUPATIONAL HEALTH INFLUENZA VACCINATION PROGRAM
• SCREENING FORM AND ACKNOWLEDGEMENT• All employees who work closely with patients are
expected to receive influenza vaccine annually. The vaccine is available as an injection or as FluMist (a brand name for live attenuated influenza vaccine administered nasally) Employees who have a medical contraindication or a religious prohibition should complete this form and check the applicable box(s). Please read and complete the entire form in clear print before receiving the vaccine.
I have one or more of the following contra indications as checked: 1.Documented allergy to eggs or egg products 2. Personal history of Guillian-Barre Syndrome within 6 weeks of receiving flu
shot 3. Severe allergic reaction to previous influenza vaccine 4. Latex allergy (avoid single dose preparation of vaccine – can receive FluMist
or multi dose injectable) 5. Other (please explain- most medical conditions are not contra indications for
influenza vaccine)____________________________________________________________________________
________________________If receiving influenza vaccine is expected in your job category please
check the below box if it applies to you:I believe my religion prohibits me from receiving influenza vaccine (please submit documentation from your clergy person supporting your religious prohibition directly to Chas Senior in Human Resources).
If you received vaccine elsewhere please complete this section:I have already received either influenza vaccine or FluMist this year (provide date of vaccination/administration and provider name)
Date: ____________ Provider Name: _____________________________
Screening Form, Continued
Implementation
• September - start advertising
Shuttle buses
Cafeteria
Public hallways
Posters for all sites
Clinic Schedules
Implementation
Late September – October
• Vaccinate non-nursing clinical groups
PT/OT – Residents – Attendings
Social Work - Child Life
• Distribute Vaccine to nursing units
• Walk-in clinics for all employees
• Vaccine available 24/7
Tracking Progress
• Essential that flu forms sent to OH daily
• Used Lawson HR system and Business Objects
Collaboration with HRIS
• Individual reports for each unit/site
• Cumulative Report comparing units/sites
Tracking Progress
• Cumbersome tracking for physicians
Excel spreadsheet, labor intensive
• Reports distributed via email bi-weekly to flu captains, managers and directors
• Track where vaccine is being used
Obstacles
• Overcoming myths
side effects
getting the flu
pregnancy/thimerosol
• Persistent resistance
Tactics
• One on one conversations with manager or OH nurse
• Letters to OB physicians
• Peer pressure
• Personal responses to emails
• CDC educational material
• Appeal to sense of professionalism
Accomplishments
%Vaccinated %Declined %Non-participation
MAIN 89% (2741/3085) 4.8%(151/3085) 6.2%(193/3085)
Ambulatory 91% (1048/1151) 6%(74/1151) 3% (29/1151)
Attending 90%* (665/735) not determined 10 % (70/735)
Physicians
*percentage based upon participation in the program: which included those vaccinated, as well as those who had a medical or religious contraindication
Accomplishments
• 93% of in-patient units and 88% of ambulatory sites >80%
• 95% participation in program
• Over 8000 doses vaccine administered to employees, affiliates, students, volunteers
What we think worked…
• Culture of organization – strong endorsement for employee flu vaccine
• Multi-disciplinary approach• Accountability• Strong media campaign• Efforts focused on vaccination- no option to
decline - during the initial campaign• Constant communication• And…………….
A Terrific Occupational Health Team
Sue Price – OHD RN
Barbara Spiotto – OHD RN
Karla Abdullah – Outpatient clinic coordinator
Sandy Kittell – OHN LPN
Kadya Hester-Bey – Clinic Coordinator
Sharon Burt – OHD Nurse Practitioner
Michelle Ashmore – NICU flu captain
Reasons for not getting vaccine
• 37% - concern with side effects
• 20% - concern about getting flu from the
vaccine
• 15% - concern about injections
• 22% - don’t want/not interested