Declination Feedback Enhancement of Influenza Vaccination Processes Mary Ellen Scales RN MSN CIC President APIC New England Chapter Manager, Infection Control Program Baystate Medical Center Springfield, MA March 2008

Baystate Medical Center Springfield, Massachusetts 650 bed Tertiary Care Referral Center 41,000 admissions/year 7,000 Employees

Learning Objectives: Identify opportunities to influence vaccination education Identify common healthcare worker declination reasons Describe feedback mechanisms used to enhance compliance with immunization

BMC Vaccinated Healthcare Workers Annually ~ 40% of our work force at BMC received Flu vaccine 2006-7 Flu season Web based program developed including paper copies for computer challenged

Education Program 2006: 7000 employees - 3,927 took on line program Influenza, methods of prevention, vaccine facts, location of vaccine clinics Program included declination process 2007: Added declination reasons to program, Automatic feedback for declination reasons Unit /area based champions as educators and vaccinators

Champion program All RN program, all settings Education session with contact hours References, posters, tool kit Networking with peers Internal List serve Q/A ,Flu case update Prevention and control CDC, MDPH updates, facility and unit based feedback

Champion Education Process Basic influenza and vaccine information Declination reasons from prior year Declination explanation, resources to enhance administration at the peer level Vaccine administration and recordkeeping

Champions at the unit level Provide easy access to vaccination Unit staff, support staff, MDs Provide peer declination education and support Unit contact for Flu prevention program Direct those with ? reaction to Employee health services or ED

Declination Pros and Cons

Declination Pros Motivation, opens dialogue Method to influence program Educate, dispel myths Offer other method of immunization delivery Measurement of population offered vaccination Similar to existing Hep B Vax process

Declination Cons Additional time and paperwork ? Value Additional time and paperwork Negative, alienating message Probing, personal, inquisitive or chastising Potential for disciplinary action Annual program vs. single process (Hep B)

Declination 2006-7 Declination process Select reason or free script Free script reasons captured, provided additional information to increase future compliance 801/3927 employees declined (20%) for other than allergy or reaction in past

Baystate Medical Center Online quiz and Vaccine Declination Process. Employees sign in with their employee number

Major Declination Reasons Don’t think it works 160 (20%) Don’t Like Needles 104 (13%) Pregnant/Breastfeeding 40 (5%) May Give me the Flu 40 (5%)

Free Script Declination Reasons Guillian Barre, Thimerosol Don’t want it, choose not to, personal choice Healthy, Good immune system, not in high risk group Never had the flu Never had the flu vaccine Do not work with patients

Has it worked ? BMC Employee Influenza Vaccination Program 2005-6: 3500 doses administered 2006-7: 4800 doses administered 2007-8: 5700+ doses administered

Mary Ellen Scales RN MSN CIC Mary.ellen.scales@bhs.org Questions? Mary Ellen Scales RN MSN CIC Mary.ellen.scales@bhs.org