The Employee Influenza Vaccine Program at The Children’s Hospital of Philadelphia Mary G. Cooney, RN, BSN, COHN-S Keit

1. The Employee Influenza Vaccine Program at The Children’s Hospital of PhiladelphiaMary G. Cooney, RN, BSN, COHN-SKeith H. St. John, MT(ASCP), MS, CIC

2. 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

3. PROGRAM GOALS Globally… • Increase the number of patient care providers receiving annual influenza vaccine • Change the culture of accountability

4. 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

5. 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.

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

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

8. KEY PROGRAM ELEMENTS • ASSESSMENT OF PREVIOUS SEASON • PLANNING • PROGRAM DESIGN • IMPLEMENTATION • TRACKING PROGRESS/REPORTS • OUTCOME ASSESSMENT

9. Assessing the previous season • What were our outcomes? • Did we achieve our goals? • What were our successes? • What challenges remain? • Who did WhatWell? • Did we achieve “herd” immunity?

10. 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!

11. 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

12. 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

13. Get Your Vaccine: Lead by Example Logo

14. Program Design Communicating our message • Public Relations flu posters cling ads CHOP intranet OHD website

15. 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

16. 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.

17. 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: _____________________________

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

19. 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

20. 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

21. 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

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

23. 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

24. 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 determined10 % (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

25. Accomplishments • 93% of in-patient units and 88% of ambulatory sites >80% • 95% participation in program • Over 8000 doses vaccine administered to employees, affiliates, students, volunteers

26. 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…………….

27. 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

28. Reasons for not getting vaccine • 37% - concern with side effects • 20% - concern about getting flu from the vaccine • 15% - concern about injections • 22% - don’t want/not interested