Raising Immunizations Safely and Effectively

Health Care Worker Campaign

RISE-HCW

David A. Nace, MD, MPH
Director, Long Term Care and Flu Programs
University of Pittsburgh Institute on Aging
July 18, 2008
naceda@upmc.edu

Objectives

• Review the background work that led to RISE-HCW

• Describe the RISE-HCW program

• Present the RISE-HCW outcomes

Questions from the 1990’s

• 1) Can a facility reach a HCW influenza immunization rate of 60% or greater?

• 2) IF SO, can the facility maintain HCW influenza immunization rates of 60% or greater over time?

• 3) IF SO, can the program be deployed to other facilities?

BHWP Pilot
Community Based Long-Term Care (LTC) Facility

• 1996 – Identified influenza immunization as QI Indicator

• 1996-98 – flu outbreaks

• 2002-03 – implemented declination form

• 2002-03 – Act 95 implemented

• 2004-05 – national shortage

Organizational Barriers

• inadequate vaccine supplies
• general vaccine inaccessibility
• lack of positive incentives for immunization
• requirement of written consent
• limited record keeping
• lack of any feedback or shared learning

Individual Barriers

• limited leadership knowledge and support

• poor staff knowledge about influenza

• negative staff attitudes about the vaccine and injections

BHWP HCW Rates

Nace DA, Hoffman EL, Resnick NM, Handler SM. Achieving and Sustaining High Rates of Influenza Immunization Among Long-Term Care Staff. J Am Med Dir Assoc February 2007; 8(2):128-133.

Questions from the 1990’s

• 1) Can a facility reach a HCW influenza immunization rate of 60% or greater?

  A = YES

• 2) IF SO, can the facility maintain HCW influenza immunization rates of 60% or greater over time?

  A = YES

• 3) IF SO, can the program be deployed to other facilities?

PLTCVP
Promoting LTC Vaccinations Project

• AMDA Foundation / Pfizer 2002 QI Award
  • 2002-2003 Season
  • 6 LTC Facilities in Western PA
• Goals
  • Improve resident immunization rates
    • Flu & pneumococcal
  • Improve HCW immunization rates
    • Flu

PLTCVP
Promoting LTC Vaccinations Project

• Design
  • 3 usual care and 3 collaborative groups
  • All facilities
    • received the ADMA Immunization Toolkit
    • Access to project team for questions/information
  • Collaborative group (3)
    • Single collaborative training session October 2002
    • Email / Phone contacts every 1-2 months Oct – February

PLTCVP
Promoting LTC Vaccinations Project

PLTCVP
Promoting LTC Vaccinations Project

Focus Group Evaluation

• Usual barriers identified
• Staff turnover problem
  • Nursing & CNA turnover of 30-55% average annually
  • Nick Castle
    • 1996-2004 OSCAR data
    • 43% ADM, 39% DON
  • Facility UC2 champion team – 200% during study

RISE Program

Raising Immunizations Safely & Effectively

RISE-HCW
Raising Immunizations Safely & Effectively-Healthcare Workers

• Created 2004-2005 season
• Collaborative effort
  • Rx Partners, LTC – a LTC pharmacy
  • University of Pittsburgh Institute on Aging
  • 9 Western PA LTC facilities
• Pharmacy based program

RISE-HCW Organizational Structure

RISE-HCW Objectives

Primary

• 60% HCW Influenza Immunization Rate

Secondary

• 80% HCW Influenza Immunization Rate

Steering Committee Tasks

• Spring
  • Season activity
  • Vaccination rates
  • Vaccine supplies & orders
• Summer
  • Vaccination rates
  • Barrier assessment
  • Educational planning
  • Communications
• Fall
  • 2 meetings
  • Early implementation barriers
  • Mid-season push

Facility Responsibilities

• Leadership Contact Team
  • Communication of information
  • Accountability
  • Leadership buy-in
  • Sense of urgency
• Designate Flu Champion
  • Coordinate immunizations
  • Coordinate education
  • Data collection
  • Dissemination of outcomes

Pharmacy Responsibilities

• Vaccine Supplies
• Defines Immunizations Process
  • Policy and Procedures
  • Forms
    • MAR
    • Preprinted labels
• Data collection
• Vaccination Clinic
  • Initial start date at each facility
  • Facility is responsible for administration
• Liaison between Steering Committee & Facilities

RISE-HCW
Tools Used

• Declination Form
  • Encouraged
• Incentives
  • Pizza party for winning facility
  • News coverage of positive outcomes
• Education
  • Training and reference materials
  • Formal training sessions
  • AMDA video
• RISE Prevention & Management Network

RISE – Program
Influenza Prevention & Management Network

18 campuses in Western PA

• Distribution list-serve
• Guidance
  • Immunization issues
  • Surveillance
  • Outbreak detection
  • Outbreak management
  • Policy development
• Regulatory assistance

Questions from the 1990’s

• 1) Can a facility reach a HCW influenza immunization rate of 60% or greater?

  A = YES

• 2) IF SO, can the facility maintain HCW influenza immunization rates of 60% or greater over time?

  A = YES

• 3) IF SO, can the program be deployed to other facilities?

  A = YES

Models of Mandatory Program Systems

Models of Voluntary Program Systems

NRT - Non-respondent tracking

NRT - Non-respondent tracking

Recommendations

1. Pharmacy Based Program
   • Overcomes turnover issue
2. Mandatory – Action Based Program
   • Explicit declination forms
   • Complete non-respondent tracking
3. Leadership Accountability
   • Require evidence based action if no improvement
   • Don’t stipulate specific rate
4. Use Care Bundles

2008-2009 Pittsburgh HCW Immunization Plans

1. UPMC Health System
   • President’s Dashboard item
     • HCW Immunization Rate
     • Declination Return Rate
2. UPMC Health Plan
   • Use of MyHealth Internet Survey
3. Allegheny County Health Department
   • Healthcare Facility Reporting of HCW Rates
     • Website posting < 60%

2007-08 UPMC Flu Vaccination Rates

Team Members