1. 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

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

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

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

5. 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

6. 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

7. 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

8. 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

9. Declination Pros and Cons

10. 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

11. 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)

12. 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

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

14. 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%)

15. 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

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

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