Hospitals take their best shot at the flu
Hospitals take their best shot at the flu
'Best practices' share winning strategies
"Everyone deserves a shot at fighting flu." The catchy slogan of the American Nurses Association (ANA) is an example of the marketing push for greater flu vaccination of health care workers. Everyone is stepping up their role to raise the influenza immunization rate.
The ANA, based in Silver Spring, MD, has recognized four hospitals that achieved high rates of immunization with aggressive campaigns. All of the programs had basic elements in common, says Nancy Hughes, MS, RN, director of the ANA's Center for Occupational and Environmental Health. They provide education on the vaccine's benefits and address the issue of side effects, they promote the campaign with clever marketing and logos, and they carefully track who has received the vaccine and who has declined.
All of the "best practice" hospitals had strong support from top leadership. "It's key to have support from the nursing leadership right from the planning stages. They can serve as role models," she says.
Below are the winning strategies of the ANA's "Best Practices in Seasonal Influenza Immunization Programs for Healthcare Personnel."
POWs and myth-busters raise rates
When health care workers at Cook Children's Health Care System in Fort Worth, TX, open their e-mail this month, they'll find a message from the president of their organization. In fact, the reminders about flu vaccination will come once a week for six weeks.
"Do it for all the children in your life." With that theme, Cook Children's emphasizes their responsibility to their pediatric patients as well as the benefits to their family's health. "We really tried to appeal to their commitment to our promise to our children," says Joyce Hood, MPH, RN, COHN-S, director of occupational health services.
The messages also add in some myth-busting information. In 2006, during an annual health screening, the health system surveyed employees who had not received the flu vaccine. Some said they felt it was a personal decision that didn't affect anyone else. The educational messages now include information about annual deaths including pediatric from influenza.
"We had an evidence-based approach," says Hood. "Every [e-mail] tackled all the issues we saw in the survey."
FluMist is available for employees who dislike injections. And the POW strategy made sure that vaccine was readily available.
The POWs are the Point of Work vaccinators who provide the flu vaccine to their co-workers. Employee health also runs mass vaccination days in which they vaccinate into the evening. The employee health clinic is open 50 hours a week for employees who come by for their vaccine.
Last year, the health system used declination statements for the first time. Employee health notified managers about employees who had not yet gotten the vaccine or signed a declination. Units also kept track of their vaccination rates. Although most of the vaccination takes place before Thanksgiving, vaccinations continue until the vaccine vials expire in late spring.
"Our goal was to get our rates up into the high 70s," says Hood. The result: 77% of the health system's 4,500 employees received the flu vaccine.
Flu vaccine 'captains' hit 80%
At Children's Hospital of Philadelphia, flu vaccination is a team effort with flu "captains" who lead other vaccinators in each unit. Every two weeks, the captains receive a report with their vaccination rates and a comparison with other units.
The "no-flu" logo a circle with a slash through "flu" was emblazoned on posters, t-shirts, and even signs on the campus shuttle bus.
"It was really an expectation for patient safety that they get vaccinated," says Mary Cooney, RN, BSN COHN-S, occupational health nurse manager. "We really emphasized patient safety and personal health."
The final score: 89% of employees received the vaccine, well above the previous high of 72%. Children's had a goal of at least 80% immunization in all nursing areas; 93% of the units met that goal.
Cooney credits both teamwork and support from top leadership for the successful campaign. "It has to be culturally accepted from your administration down to your workers," she says.
The occupational health department also functioned smoothly as a team, as the staff ran flu vaccine clinics, visited those departments that didn't have an in-house RN to provide vaccines, distributed and tracked vaccine, and monitored vaccination rates.
It was mandatory for employees to participate in the flu vaccine program either to get the vaccine or to sign a declination. But there were no consequences for those few who did not comply, Cooney says.
The declinations revealed the usual reasons why employees avoided the vaccine. More than a third (37%) said they were concerned about side effects; 22% simply said they didn't want it. Twenty percent erroneously said they thought they could get the flu from the flu vaccine, and 15% simply didn't like injections (although FluMist nasal vaccine was available).
While Children's didn't rely on rewards or prizes to rally employees about the flu vaccine, there was one incentive: Everyone who got the flu vaccine had their name in a raffle for an iPod and iTunes gift card.
Cooney and the multidisciplinary flu vaccine task force are gearing up for another major effort to maintain that high vaccination rate. "I think it gets easier each year as certain things fall into place. When these signs go back up, they'll know it's flu vaccination time again," she says.
Taking it from the top
The CEO and his executive team were among the first to roll up their sleeves and get the flu shot at Genesis Health System in Davenport, IA. The photo of those shots went out to all the employees in the hospital newsletter. It was the opening salvo of an aggressive flu vaccination campaign.
Employees then received daily updates with the ever-rising vaccination rates for the next two weeks. Each unit had flu "champions" who helped lead the campaign. Genesis Health System used that momentum to promote the flu vaccine with mobile clinics that worked from early in the morning to late at night.
The goal was to deliver most of the vaccine during the intense two-week campaign and to have as many employees vaccinated before Dec. 31 as possible. However, the health system continued vaccinating throughout the flu season.
The result was impressive. Genesis Health System raised its vaccination rate from 76% to 89%. "We've always had high numbers compared to other hospitals but we knew we could do better," says Lisa Caffery, BSN, MS, RN, BC, CGRN,CIC, manager of infection prevention.
Support from top leadership was key, she says. "Our administrative team was behind it 100%," she says.
The flu vaccination team tracked the vaccinations with a database they accessed on laptops. Employees who declined vaccination still needed to speak to a vaccinator, who could talk to them about their reasons. (Every employee also is required to complete an annual online flu education module.)
Of the health systems 5,000 employees, 418 declined, including 77 due to allergies or other medical reasons and 22 because of "moral objection."
This year, employees won't be able to decline for any reason other than medical contraindications. The health system is trying to meet a state mandate for a 95% rate of health care worker flu immunization by 2010.
"We felt we had pushed as far as we could this year," says Caffery. "In order to continue to move that number forward, our executive [team] and hospital epidemiologist felt it had to be mandatory."
'No flu zone' boosts vaccine
In 2005, Emory Healthcare in Atlanta decided it wanted to be better than average. Nationally, about 40% of health care workers receive the flu vaccine. By 2006, Emory Healthcare pushed its own rate to 67% and improved that even more to reach 72% in 2007.
"Our strategy was to make sure we were able to reach each employee to give them the education about the vaccine, the benefits, and how important it was to patient safety and quality of care," says Cynthia Hall, RN, COHN-S/CM, associate director of Employee Health Services.
The health system began by creating a "No Flu Zone," a catchy red logo with the international symbol for "no." The new logo appeared on posters, t-shirts, and educational materials.
An aggressive campaign included mobile carts and monthly meetings of a flu vaccine steering committee. Employees were asked to sign a declination statement if they did not receive the vaccine.
The next year, the flu vaccine team wanted to know more about the employees who didn't get the vaccine. An online survey, focus groups, and interviews revealed that many of them simply said it was their "personal decision." Thirty percent said they feared side effects.
Employees also said they wanted to know more about the side effects and benefits of the flu vaccine and how they work. So Emory Healthcare developed a 10-minute educational video featuring employees. "We asked employees why they choose to get the vaccine, why they didn't, and addressed the myths that people have," Hall says.
They showed the video at flu forums and staff meetings, and it was available online. "We had a lot of people who didn't have a lot of knowledge about the vaccine. After viewing the video, they chose the take the vaccine. It definitely made a difference," she says. They had vaccinators in every clinical unit and ran 24-hour "flu marathon" clinics to provide vaccines on every shift.
Emory Healthcare also made it clear that everyone was expected to participate in the campaign either by getting the vaccine or signing a declination. "We wanted each and every employee to be accountable, be responsible, and to participate," says Hall.
"Everyone deserves a shot at fighting flu." The catchy slogan of the American Nurses Association (ANA) is an example of the marketing push for greater flu vaccination of health care workers. Everyone is stepping up their role to raise the influenza immunization rate.Subscribe Now for Access
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