Developing an effective seasonal influenza vaccination program

1. Developing an effective seasonal influenza vaccination program Use of the five principles of transformational leadership to facilitate cultural change Joyce Hood, MPH, RN, COHN-S

2. Impact of seasonal influenza disease in healthcare • 850,000 hospitalizations/year in U.S. • 50,000 deaths/year in U.S • Hospital outbreaks occur when healthcare worker vaccination rates are low • Study: when the vaccination rate for healthcare workers increased to 67%, hospital-acquired infections in patients decreased from 32% to 0 within the same time frame • Causes up to 75 million lost work day per year Thompson, et al, 2004, 2005; Wilde, 1999 CDC, 2006; Salgado, 2004; Nichol, 2001

3. 2001-2002 influenza vaccine program • Passive and did not utilize staff time efficiently • Not visibly supported by administration • Vaccination rates were neither calculated nor reported • No influenza education

4. -Challenge the process HCW vaccination rate nationwide = 38% (CDC)

5. -Challenge the process-Enable others to act • Mass vaccination days on site for the larger companies • Volunteers from staff nurses to assist with giving vaccine • Vaccination rates: feedback to management • Educational flyers to all departments for posting • Trained “Point of Work” (POW) vaccinators in key departments such as PICU, NICU, and ED • Computer-based training module that was required for annual education

6. CCHCS influenza vaccination rates, 2002-2006 HCW vaccination rate nationwide = 38% (CDC)

7. -Enable others to act • Questionnaire was administered to those employees who did not receive influenza vaccine in the 2006-2007 season

8. Reasons for not getting influenza vaccine, 2006-7 (n = 478)

9. Opportunistic • The Joint Commission had just published an infection control standard regarding influenza vaccination • Influenza vaccination both employee and patient safety issue • Calculate rates • Ongoing education • Declinations

10. -Enable others to act-Challenge the process • Multi-disciplinary team to address opportunities for improvement • Nursing administration • Evidence-based practice and research director • Internal communications director • Results of questionnaire used to determine delivery strategy

11. -Inspire a shared vision • Enlisted the spirits of the caregivers of children and their commitment to the “Promise” of Cook Children’s: • “Knowing that every child’s life is sacred, it is the promise of Cook Children’s to improve the health of every child in our region through the prevention and treatment of disease, illness and injury”.

12. -Enable others to act • Personalized, patient-centered, evidence-based approach • Vaccination strategies: • Unit staff meetings • Night shift employees at alternative times (such as in the evening when they arrive rather than early morning as they leave). • “Skills Week” • Declination for those who, after education, still decided to opt out of vaccination • Upper management support • Sent out weekly email “slides” to their staff supporting influenza vaccination • New CBT module on pandemic influenza required for all staff

13. It’s flu vaccine time – get one for you and all the children in your life! Flu vaccine protects your health, but also prevents you from spreading the disease to your patients, your own children, your nieces and nephews, neighbors, etc. – all the children in your life!

14. Dispelling myths • Flu vaccine does not cause the flu • Flu vaccine is safe • Pregnant women shouldget a flu vaccine • The side effects of the vaccine are typically mild and short-lived • Not just older people need flu vaccine - flu can be a serious illness American College of Obstetricians & Gynecologists, 2006 CDC, 2008

15. Benefits of getting flu vaccination • ↓ mortality rate of vulnerable hospitalized children and adults • ↓ hospital-acquired influenza • ↓ Staff illness • ↓ costs from illness to you, health care, & society • Helps protect you, your family, and your patients Koslap-Petraco, 2008

16. CCHCS influenza vaccination rates, 2002-2007 CDC/HRET Hospital Influenza Prevention Survey, 2006 HCW Vaccination Rate Nationwide = 54%

17. -Encourage the heart • 2008 award recipient of the American Nurses Association “Best Practice in Seasonal Influenza Immunization”

18. 2008-2009 season-Enable others to act-Model the way • Multi-disciplinary team added • Internal communications director • Patient safety officer (physician) • Utilized all previous years’ elements • Highly visible leadership modeling

19. Key elements of 2008-2009 season • Upper leadership modeling • Addressed vaccine mismatch from previous year • Vaccination progress visual on system intranet site, updated weekly • Mandatory vaccination in caregivers who enter BMT unit

20. -Enable others to act-Model the way

21. -Model the way-Inspire a shared vision • All senior and mid level management were challenged to “go first” and have their photographs taken getting their influenza vaccine • Became a challenge and almost competitive

22. It’s flu vaccine time again – follow the leader!! “Health care administrators should consider the level of influenza vaccination coverage of their health care workers to be one measure of a patient safety and quality program”. CDC, 2008

23. Care---don’t share! Protect you and all of the children in your life! Vaccine strain mismatch • If matched, vaccine is usually 70-90% effective • Last season (2007-2008) there was a vaccine mismatch. Studies indicated that it was at least 44% -54% effective. • This year, the vaccine is totally reformulated. CDC, 2008; Blazek, 2008

25. Weekly feedback on progress

26. CCHCS influenza vaccination rates, 2002-2008 CDC/HRET Hospital Influenza Prevention Survey, 2006 HCW Vaccination Rate Nationwide = 54%

27. Encourage the heart • 2007-2008 and 2008-2009 influenza vaccination programs will be published in national peer-reviewed journal in August, 2009 • Received recognition from the Joint Commission and from the DFW Hospital Council

28. “Take 3 for you and me” Stop and “Take 3” for yourself and other important people in your life Flu vaccine may be given in three doses—one seasonal and two H1N1