The Employee Influenza Vaccine Program at The Childrens Hospital of Philadelphia Mary G' Cooney, RN,

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The Employee Influenza Vaccine Program at The
Childrens Hospital of PhiladelphiaMary G.
Cooney, RN, BSN, COHN-SKeith H. St. John,
MT(ASCP), MS, CIC
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CHOP Structure

• 420 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

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PROGRAM GOALS

• Globally
• Increase the number of patient care
• providers receiving annual influenza
• vaccine
• Change the culture of accountability

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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

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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.

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PARTICIPATION DEFINED

• All eligible employees identified as having
• patient contact required to
• Receive an influenza vaccine or
• Complete a declination form

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CHOP Participants

• 4225 Employees
• Main Campus
• Hospital - Out-patient clinic Rehab
• Satellite Sites
• Specialty Care
• Primary Care
• Physician Practices
• 735 Surgical and Anesthesia Affiliates

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KEY PROGRAM ELEMENTS

• ASSESSMENT OF PREVIOUS SEASON
• PLANNING
• PROGRAM DESIGN
• IMPLEMENTATION
• TRACKING PROGRESS/REPORTS
• OUTCOME ASSESSMENT

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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?

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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!

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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

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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

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Get Your Vaccine Lead by Example Logo
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Program Design

• Communicating our message
• Public Relations
• flu posters
• cling ads
• CHOP intranet
• OHD website

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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

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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.

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Screening Form, Continued

• 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
  _____________________________

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Implementation

• September - start advertising
• Shuttle buses
• Cafeteria
• Public hallways
• Posters for all sites
• Clinic Schedules

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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

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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

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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

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Obstacles

• Overcoming myths
• side effects
• getting the flu
• pregnancy/thimerosol
• Persistent resistance

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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

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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

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Accomplishments

• 93 of in-patient units and 88 of ambulatory
  sites gt80
• 95 participation in program
• Over 8000 doses vaccine administered to
  employees, affiliates, students, volunteers

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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.

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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

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Reasons for not getting vaccine

• 37 - concern with side effects
• 20 - concern about getting flu from the
• vaccine
• 15 - concern about injections
• 22 - dont want/not interested