Raising Immunizations Safely & Effectively

Health Care Worker Campaign

RISE-HCW

David A. Nace, MD, MPHDirector, Long Term Care and Flu Programs

University of Pittsburgh Institute on AgingJuly 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 PilotCommunity 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

0

20

40

60

80

100

120

Flu Season

Pecentage of StaffVaccinated

54.03 55.32 77.52 62.79 63.03 64.09 93.67 95.45 73.71 86.02

1996-1997

1997-1998

1998-1999

1999-2000

2000-2001

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

BHWP HCW RatesNace 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?

PLTCVPPromoting 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

PLTCVPPromoting 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 ResultsPromoting LTC Vaccinations Project

Facility 2002 HCW Flu Rate %

2003 HCW Flu Rate %

Δ HCW Flu %

Non Collaborative 1 23.1 12.5 -10.6Non Collaborative 2 47.1 30.3 -16.7Non Collaborative 3 17.8 34.7 16.9Collaborative 1 56.9 67.2 10.3Collaborative 2 14.3 36.2 21.9Collaborative 3 46.4 46.8 0.4

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 ProgramDavid A. Nace, MD, MPH

Program Director

RISE Steering Committee

RISE - HCW

RISE-Influenza Prevention and

Management Network

RISE – Patient Immunization

Rx Partners, LTC

RISE-HCWRaising 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-HCWOrganizational Structure

RISE STEERING CMT

Representatives include Administration, Nursing, Medical Director,

Marketing, Human Resources, Staff Development

Primary UPMC SRCFacilities

Rx Partner, LTC Facilities

Community Drug Facilities

A subsidiary of Rx Partners, LTC

Rx Partners, LTC

Facility Beds *skilled only when multi-level

No Staff(2007)

Urban/Rural

County Union

A 139* 356 Urban Allegheny No

B 59* 158 Urban Allegheny Yes

C 100 107 Rural Venango No

D 150 199 Urban Butler No

E 59 96 Rural Mercer No

F 145 176 Urban Allegheny No

G 180 243 Urban Allegheny No

H 60* 294 Urban Butler Yes

I 214 180 Rural Venango No

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-HCWTools 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

APPENDIX CRISE-HCW FlU IMMUNIZATION RATES 2001-2008*

(Baseline Seasons = 2001-2004, RISE Intervention Seasons = 2004-2008) (* 2008 Data as of May 7, 2008)

0%

20%

40%

60%

80%

100%

1 2 3 4 5 6 7 8 9

FACILITY

2001-2002

2002-2003

2003-2004

2004-2005

2005-2006

2006-2007

2007-2008*

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

Mandatory Programs(Action Based)

Mandatory Vaccination(Shot or Mask)

eg Virginia Mason

Mandatory AnswerWritten Declination

(Shot or Sign)eg UPMC Cranberry Place

Mandatory AnswerTechnology (Intranet)

(Shot or Click)eg Cleveland Clinic

UPMC

Models of Voluntary Program Systems

Voluntary Programs(Passive Response)

No DeclinationNo NRT

eg UPMC Canterbury Place

DeclinationLimited NRTeg Asbury Heights

NRT - Non-respondent tracking

Facility Rate Declination NRT

Caring Place 90% Yes Complete

Grove Manor 88% Yes Complete

Cranberry Place 86% Yes Complete

Sugar Creek Station 83% Yes Complete

Asbury Heights 75% Yes Partial

Seneca Place 70% Yes Complete

Sherwood Oaks 66% Yes Partial

Heritage Place 61% No Partial

Canterbury Place 32% No None

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

Facility Immunization Rate EstimatesUPMC Presbyterian Shadyside ( & WPIC) 33%UPMC South Side 37%UPMC McKeesport 44%UPMC Children’s 44%UPMC Magee 40%UPMC St. Margaret’s 48%UPMC Northwest 67%UPMC Horizon 50%UPMC Passavant 42%UPMC Braddock 56%UPMC Bedford 52%UPMC Mercy 44%Physician Services Division 30%

Team Members

• RISE Steering Committee– Sandra Carroll– Daniel Grant– Jay Harper– Steven Handler– Shikha Iyengar– Mary Ann Suda– Mark Tannis– Barry Young– Paula Carlock– Scott Stephens

• Facilities and their teams– Asbury Heights– Canterbury Place– Caring Place– Cranberry Place– Grove Manor– Heritage Place– Seneca Place– Sherwood Oaks– Sugar Creek Station