Located 15 Miles West of Ann Arbor, Michigan 113 Total Beds (Adult)

1. Proactive Approach for Improving Rates of Pneumococcal VaccinationConstance O’Connor, Infection ControlAmy Hetzler, PharmacyMarch 2006

2. Located 15 Miles West of Ann Arbor, Michigan • 113 Total Beds (Adult)

3. Background: • Immunization Standing Order Published in the Federal Register October 2, 2002 • Chelsea Community Hospital Joined Southeast Michigan Partners Inpatient Immunization Pilot Project • Hospital Policy Developed September 2003 • Initiated by Director, Nursing Case Management • Sought Physician’s Input and Buy In • Received Strong Pharmacy Participation • Flu Season “Kick-Off”

4. Targeted Population at Highest Risk • Influenza and Pneumonia 5th Leading Cause of Death of Death in the Elderly • Elderly Admitted Most Often to: • Medical/Surgical Unit 24 Beds • Physical Rehabilitation 21 Beds • Intensive Care 6 Beds Goal: Aspire to Healthy People 2010 Objective of a 90% Vaccination Rate

5. 2005 “Time Out”Checking the Game PlanWas it Working?

6. No. It Was Not Working. We Did Not Meet the Goal of 90% Vaccination. • A Medical Record Audit for January 2005 Found: • 126 Patients Were Eligible For Screening • 111 Patients Were Screened • Of the 111 Patients Screened 28 Were Eligible for Vaccination • Of the 28 Eligible for Vaccination 21 Were Vaccinated Rate of Vaccination for the Month Studied = 75%

7. Huddle Time. Reviewed the Policy and the Process Met With Nurses and Pharmacy to Identify Barriers to Compliance

8. Barriers to ComplianceIdentified • Unable to Obtain History due to Patients: • Who Were Confused or Too Ill or Unable to Respond • Often Re-Admits But No Easy Way To Check Vaccination History • Discharge to Another Unit Before Dose Arrived • Missed Doses When Patient Was Febrile or Discharged from Hospital

9. Tackling the Problem • Vaccination History was Entered in a Data Base and “Flagged” on the Face Sheet to Aid with History • Changes Made to Standing Order Instructing Nurse to “Carry-Over” the Order for the Next Shift on the MAR if Patient Was Febrile or Discharged to Another Unit Before Dose Was Available • Developed educational opportunities and incentives to learn how to use the revised Standing Order

10. Implementing the New Game PlanAnd Stimulating Interest!Education for Nurses KeyLunch and LearnFlyers, PostersPrizes for Completing Self-Grading Quiz and Candy

11. Med-Surg Nurses Responded!

12. ICU Nurses and Unit Secretary Took Part

13. Physical Rehabilitation Nurses Pro-Vaccination!

14. Did We Get a Grip on the Problem?Did the Interventions Remove Any Barriers to Vaccination? • Did the Rate of Pneumococcal Vaccination Improve after the Interventions? • To Answer These Questions and Evaluate the Effectiveness of the Interventions, Another Audit Was Performed in January 2006 and Compared to the January 2005 Findings.

15. January 2006 • 111 Patients were Eligible to be Screened and were Screened • 100 Patients Screened did not Meet Criteria for Vaccination: • 9 Refused, 4 Physician Order not to Give, 73 had Previously Received the Vaccine, 13 did not meet criteria, 1 was Febrile • 1 Patient Met Criteria, Patient Discharged Before Receiving Vaccine

16. 11 Patients Eligible10 Patients Vaccinated • 90% Vaccination Rate January 2006 Audit • 15% Increase Over the January 2005 Audit Goal of 90% Vaccination Rate Met

17. What Worked • The average number of nurses working in a 24 hour period on the 3 units = 26 • The return on the Self-Grading Quiz = 26 • The quiz stressed the life saving importance of vaccination and the revised Standing Order • The Standing Order “Cheat Sheet” was posted at the nursing stations, by the nurses, as an easy reference to who should receive the vaccine.

18. What Didn’t Work • Although the “Lunch and Learn” session was well advertised, it was poorly attended. • Those attending were Nurse Directors and Pharmacy Staff. The audience we hoped to reach were staff nurses. It is difficult for on-duty nurses to get away. In our country setting, most nurses live a distance away and would not drive in for a non-mandatory offering.

19. Conclusion • A concerted effort beginning with the Director, Nursing Care Management, with the oversight of a Pharmacist working with Nursing on the three units, demonstrated a commitment to the importance of vaccination • The addition of Infection Control helped identify barriers to vaccination and to provide baseline data. • Combining forces was helpful in problem solving, planning, implementing and evaluating the effectiveness of interventions

20. Finally, Though it is a Team Effort… We recognize that without nurses who take the time to screen and vaccinate, the best program in the world could not succeed. A Special “Thank You” will go out to participating Nurses via the hospital newsletter and posters put up on employee announcement boards.