TEMPLATE DESIGN © 2008 Multi-Level Intervention Model Using Quality Improvement Tools to Improve...
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TEMPLATE DESIGN © 2008 www.PosterPresentations.com Multi-Level Intervention Model Using Quality Improvement Tools to Improve Seasonal Influenza Vaccination at University Health System Jose Cadena 1,3 , Teresa Prigmore, MHA 2 , Jason Bowling, MD 1,3 , Beth Ann Ayala, MT(ASCP), MS 2 , Leni Kirkman 2 , Amruta Parekh, MD, MPH 1 , Theresa Scepanski 2 and Jan Patterson, MD (1) Department of Medicine, Division of Infectious Diseases. University of Texas Health Science Center, San Antonio, TX, (2) University Health System, San Antonio, TX, and (3) South Texas Veterans Health Care System Abstract Results Discussion Results: Vaccination rates Results Additional Interventions Conclusions •We used QI tools to improve employee seasonal influenza vaccination rate. This allowed adaptation of change by adjusting interventions as we were implementing the project. •We followed recommendations from the ACIP, HICPAC as well as more recent data that links improved vaccination to enhance acceptance of vaccination. •In addition, the easily accessible weekly dashboard showing rates of vaccination by department prompted healthy competition between units. •The support of the health system board and leadership was strong and visible. •Residents compromised the largest hospital unit and proactive work with the residency program directors for optimal documentation of their vaccination at other sites is planned. •We will continue our Plan-Do-Study-Act cycle in planning next season’s campaign and look for ways to contact the additional 8% of the healthcare workers for vaccination. •Interventions will be designed to address the most common stated reasons for declination. During the 2008-2009 influenza season, 81.9% of employees were contacted for influenza vaccination. Total vaccination rate was 58.8%: 54.4% accepted vaccination at UHS, and an additional 4.4% received vaccination outside UHS. After interventions (September-November 2009),92.2% were contacted and the total vaccination rate increased to 76.6%, a 17.8% increase from the pre-intervention period (OR 2.7, 95% CI 2.5-2.97, p: <0.01). Background and Introduction • Influenza is a significant cause of morbidity and mortality among hospitalized patients. •It is a tremendous cost to society and to healthcare services in the United States, including over 10 billion dollars a year in direct medical care cost. •Healthcare workers are an important reservoir for transmitting disease to susceptible populations. Hospital and long term care facilities outbreaks of influenza have been reported. Asymptomatic infection is common. •Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) recommend annual influenza vaccination of all HCW. •Strategies recommended include providing education, administration on-site, signed declination form if HCW elects not to take the vaccine, monitored rates of vaccination and feedback to HCW, and use the rate of HCW vaccination as a measure Materials and Methods • University Health System (UHS) is located in San Antonio, Texas and includes a 600 bed tertiary care hospital with a solid organ transplant program, hematology oncology unit, 16 outpatient clinics, and ED with >70,000 visits per year. •Vaccination rates remained relatively low for seasonal influenza during the 2008-2009 season (58.8%). •A quality improvement (QI) team including employee health, infection control, corporate communications, nursing, medical staff leadership, residency program leadership, hospital epidemiology and quality management was formed and met weekly. •The proposed Aim was: to improve the rate of employee influenza vaccination 80% or more at UHS for the 2009-2010 influenza season. This initiative was supported by hospital leadership. •QI tools and techniques used included brainstorming, force-field analysis, cause-effect diagram, process flow chart, dashboards for audit/feedback, Pareto analysis and Gantt chart . The QI team met once a week between September and December 2009. •“Contacted” was defined as documentation received by employee health that the HCW received or declined vaccine. Initial meeting (September 2009): vaccination data from previous years was presented, the Aim of the project was selected, setting up a goal to achieve a vaccination rate of 70% by November 1 and 80% by December 1, 2009. •Initially a brainstorming session was performed to identify causes for the low vaccination rate where identified, and a Force Field analysis was performed (see figures 1 and 2). Results Interventions: •An audit/feedback system to monitor vaccination rates, timely web based feedback to all units of UHS. •Involve educators to promote educational campaign •Recruit volunteers to increase access to vaccination on the units and at conferences • Audit/ feedback data provided to residency program directors in dashboard format •Residency program directors provide documentation of residents vaccinated at affiliated sites Follow up •During subsequent meetings: • Units of the hospital with very low Additional ideas to promote vaccination were implemented: •An influenza website was established, including FAQs and a flu blog with subject matter expert content. •Photos of UH leadership getting vaccine were posted on the website and published in UH newsletter. •Weekly updates of rates by department were posted on line and sent to unit managers. •Vaccination was promoted on screen savers throughout the hospital and with a telephone on-hold message. •A letter from the CEO was sent to employees to encourage vaccination. •From September to December 1 2009, the seasonal influenza vaccination rate was 76.6% (4271/5578). Of these 67.5% received vaccination at UHS, 9.1% received vaccination from other providers. Among the 92.4% contacted, 82.9% (4147/5578) received vaccination and 863 (17.1%) declined vaccination. In 2008,58.8% vaccination rate Institution Vaccine & Side Effects Logistics H ard to contacteveryone Takes tim e to sw ay people back to acceptance Education A fraid ofgetting flu from vaccine M isconception aboutlive vaccine Placebo effect Previous experience,cold or otherillness aftervaccinated Fearofside effects Lack ofknow ledge A llproceedingsand recordsofthe Q uality/Risk M anagem ent Com m ittee are confidential and allprofessionalreview actionsand com m unications m ade to the Q uality/Risk M anagem entCom m ittee are privileged underTexasand federallaw .Tex. O cc. Code A nn. Chps151 & 160;Tex H ealth A nd Safety Code § 161.032;and 42 U .S.C . 11101 § etseq. B elieve the vaccine is a guess H 1N 1: How can they m ake itin 3 m onths w hen usually takes a w hole year? Lack oftim e N oteducated aboutflu Egocentric individuals (only effectself) N otenough facts H 1N 1 R isk Population is changing Lack oftrustin people w ho m ake vaccine N otpriority to be know ledgable aboutvaccine TV alw ays negative H ard to overcom e individualbeliefs Vocalpeople sw ay others O nly focuses on flu during flu season H ave neverhad the flu,so notconcerned People O bjectto putting substances in theirbody C ore belief PeerPressure Lack ofinterest Pastexperience U nitculture Leadership Lack ofbuy-in D on’tgive tim e to staff D on’tbelieve D on’tgetit D on’tencourage Lack ofinterestby leader Executive leadership does notsetexam ple Leaderlacks leadership skills M ustgo above and beyond Lack ofaccountability Lack ofpeerpressure atthis level N o ram ifications to leader ifstaffnotvaccinated Lack audit/feedback N o ram ifications to executive leaders D elay in shipm ents Figure 1. Cause- Effect diagram describing the causes for the low rate of vaccination during the 2008-2009 Influenza season R estraining Forces U H m anagem entstrongly suports the Em ployee Flu Vaccination Inititaive → ← People Factors: Staffdonotbelieve in getting vaccinated due to religious causes, lack oftrust, m ortality, com plications Im m unization Clinic w ell staffed, know ledgable, updated on vaccination inform ation → ← Peer/U nitpressure to resistvaccination → ← Lack oftim e, institution only focuses on flu during Flu season Strong vaccination cam paign → ← Lack ofeducation: notenough facts → ← ↓ These forces resulted in low em ployee flu vaccination Force Field A nalysis G oal: To increase the Em ployee Seasonal Flu Vaccination R atefrom 58% to 80 % by N ovem ber15th 2009,atU niversity H ospital in San A ntonio,TX D riving Forces C urrentE m ployee Flu vaccination rate = 58% •Concurrently, the process of vaccination was mapped using a process flow chart (Figure 3). With the use of force field analysis, the findings of the brainstorming session and the cause-effect diagram, interventions were planned to try to increase rate of vaccination, and a Gantt chart was developed Figure 2. Force Field Analysis Figure 3. Pre intervention Flow Diagram The most common reasons for declination are presented on the Pareto Chart below (Figure 5) Figure 4. Vaccination rates over intervention period A QI team-based, interprofessional, and multidisciplinary approach including employee health, infection prevention, corporate communications, nursing, medical staff leadership, residency program leadership, and quality management was chartered by UHS leadership and met weekly to increase the rate of voluntary seasonal influenza vaccination. Employees were educated through multiple channels, including an influenza intranet website. Weekly dashboards on the website allowed unit directors to track vaccination rates by department. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the voluntary vaccination rate. References 1. Molinari NA, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007 Jun 28;25(27):5086-96. 2.Salgado CD, et al. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004 Nov;25(11):923-8. 3. Pearson ML, et al. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Feb 24;55(RR-2):1-16. 4. Caban-Martinez AJ, et al. Sustained low influenza vaccination rates in US healthcare workers. Prev Med Jan 15. 5. Kohn KT CJ, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999. 6.Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA 2005 May 18;293(19):2384-90. 7.Hannah KL, Schade CP, Cochran R, Brehm JG. Promoting influenza and pneumococcal immunization in older adults. Jt Comm J Qual Patient Saf 2005 May;31(5):286-93. 8. Nowalk MP, et al. Improving influenza vaccination rates in the workplace: a randomized trial. Am J Prev Med Mar;38(3):237-46. 9.Stewart AM. Mandatory vaccination of health care workers. N Engl J Med 2009 Nov 19;361(21):2015-7. 10. Loeb M et al. Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers A Randomized Trial . JAMA. 2009;302(17):1865-1871. Background: Healthcare workers (HCW) with influenza may infect patients; transmissibility can begin one day before symptom onset and up to 50% of infections may be subclinical. Seasonal influenza vaccine is 70-90% effective in preventing infection in healthy adults and reduces absenteeism. ACIP, SHEA, and IDSA have recommended that all HCW be immunized. An 80% vaccination rate may provide “herd” immunity in a hospital setting. Previous seasonal influenza vaccination rates were < 60% for University Health System (UHS), a 600 bed tertiary care hospital with a solid organ transplant program, hematology oncology unit, 16 outpatient clinics, and ED with >70,000 visits per year. Objective: Use quality improvement (QI) tools to improve the employee seasonal influenza vaccination rate to 80% or more at UHS for the 2009-2010 influenza season. Methods: Prior flu vaccination rates were reviewed with the UHS Board, who supported universal voluntary vaccination of employees. A QI team including employee health, infection control, corporate communications, nursing, medical staff leadership, residency program leadership and quality management was chartered by UHS leadership and met weekly. QI tools used: brainstorming, force-field analysis, cause-effect diagram, process flow chart, dashboards, Pareto analysis and Gantt chart. Results: For the 2008-2009 season (Oct-March) prior to the intervention, the vaccination rate was 58.8% (2989/5496). Interventions included distribution of flu vaccine kits to UHS ward and clinic units, Grand Rounds presentations for major departments, campaign announcement to unit directors, development of a UHS influenza website with information and a flu blog, screensaver reminders, employee emails, and phone messages. A color-coded dashboard displaying vaccination rates by UHS department was posted on the UHS intranet. Beginning September 2009, 90% (5010 /5569) active UHS employees were contacted & returned an influenza vaccination form. Among those contacted, 83% (4147/5010) received vaccination and 863 (17%) declined. The most common reasons for declination were: fear of getting flu (126; 14.6%), side effects of vaccine (80; 9%) and doubt of effectiveness (63; 7%). Medical contraindication was uncommon (47; 5%) . After the QI team interventions (September-November 2009), the overall vaccination rate increased to 76.6%, (4271/5578) an 17.8% increase from the pre-intervention period (OR 2.7, 95% CI 2.5-2.97, p: <0.01). Conclusions: A QI team-based, interprofessional and multidisciplinary approach significantly increased the rate of seasonal vaccination. The interventions and increased availability of vaccines enhanced staff awareness. Weekly dashboards on the web site helped unit directors track vaccination rates. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the vaccination rate. Figure 5. Pareto Chart for Employees not taking the Flu Vaccine at UHS
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Transcript of TEMPLATE DESIGN © 2008 Multi-Level Intervention Model Using Quality Improvement Tools to Improve...
TEMPLATE DESIGN © 2008
www.PosterPresentations.com
Multi-Level Intervention Model Using Quality Improvement Tools to Improve Seasonal Influenza Vaccination at University Health SystemJose Cadena1,3, Teresa Prigmore, MHA2, Jason Bowling, MD1,3, Beth Ann Ayala, MT(ASCP), MS2, Leni Kirkman2, Amruta Parekh, MD, MPH1, Theresa Scepanski2 and Jan Patterson, MD1,3
(1) Department of Medicine, Division of Infectious Diseases. University of Texas Health Science Center, San Antonio, TX, (2) University Health System, San Antonio, TX, and (3) South Texas Veterans Health Care System
Abstract Results
Discussion
Results: Vaccination rates
Results Additional Interventions
Conclusions
•We used QI tools to improve employee seasonal influenza vaccination rate. This allowed adaptation of change by adjusting interventions as we were implementing the project. •We followed recommendations from the ACIP, HICPAC as well as more recent data that links improved vaccination to enhance acceptance of vaccination.•In addition, the easily accessible weekly dashboard showing rates of vaccination by department prompted healthy competition between units.•The support of the health system board and leadership was strong and visible. •Residents compromised the largest hospital unit and proactive work with the residency program directors for optimal documentation of their vaccination at other sites is planned.•We will continue our Plan-Do-Study-Act cycle in planning next season’s campaign and look for ways to contact the additional 8% of the healthcare workers for vaccination. •Interventions will be designed to address the most common stated reasons for declination.
During the 2008-2009 influenza season, 81.9% of employees were contacted for influenza vaccination. Total vaccination rate was 58.8%: 54.4% accepted vaccination at UHS, and an additional 4.4% received vaccination outside UHS. After interventions (September-November 2009),92.2% were contacted and the total vaccination rate increased to 76.6%, a 17.8% increase from the pre-intervention period (OR 2.7, 95% CI 2.5-2.97, p: <0.01).
Background and Introduction
• Influenza is a significant cause of morbidity and mortality among hospitalized patients. •It is a tremendous cost to society and to healthcare services in the United States, including over 10 billion dollars a year in direct medical care cost. •Healthcare workers are an important reservoir for transmitting disease to susceptible populations. Hospital and long term care facilities outbreaks of influenza have been reported. Asymptomatic infection is common.•Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP) recommend annual influenza vaccination of all HCW. •Strategies recommended include providing education, administration on-site, signed declination form if HCW elects not to take the vaccine, monitored rates of vaccination and feedback to HCW, and use the rate of HCW vaccination as a measure of patient safety quality program .•Despite importance of influenza vaccination and proven effectiveness, vaccination among U.S. HCW typically remains below 50%.
Materials and Methods
• University Health System (UHS) is located in San Antonio, Texas and includes a 600 bed tertiary care hospital with a solid organ transplant program, hematology oncology unit, 16 outpatient clinics, and ED with >70,000 visits per year.•Vaccination rates remained relatively low for seasonal influenza during the 2008-2009 season (58.8%). •A quality improvement (QI) team including employee health, infection control, corporate communications, nursing, medical staff leadership, residency program leadership, hospital epidemiology and quality management was formed and met weekly.•The proposed Aim was: to improve the rate of employee influenza vaccination 80% or more at UHS for the 2009-2010 influenza season. This initiative was supported by hospital leadership. •QI tools and techniques used included brainstorming, force-field analysis, cause-effect diagram, process flow chart, dashboards for audit/feedback, Pareto analysis and Gantt chart . The QI team met once a week between September and December 2009.•“Contacted” was defined as documentation received by employee health that the HCW received or declined vaccine.
Initial meeting (September 2009): vaccination data from previous years was presented, the Aim of the project was selected, setting up a goal to achieve a vaccination rate of 70% by November 1 and 80% by December 1, 2009. •Initially a brainstorming session was performed to identify causes for the low vaccination rate where identified, and a Force Field analysis was performed (see figures 1 and 2).
Results
Interventions: •An audit/feedback system to monitor vaccination rates, timely web based feedback to all units of UHS. •Involve educators to promote educational campaign•Recruit volunteers to increase access to vaccination on the units and at conferences• Audit/ feedback data provided to residency program directors in dashboard format•Residency program directors provide documentation of residents vaccinated at affiliated sitesFollow up•During subsequent meetings:• Units of the hospital with very low rates of vaccination were identified and a process flow chart that described the process implemented during the current season was reviewed. •Additional information was added to the cause and effect diagram.
Additional ideas to promote vaccination were implemented: •An influenza website was established, including FAQs and a flu blog with subject matter expert content.•Photos of UH leadership getting vaccine were posted on the website and published in UH newsletter. •Weekly updates of rates by department were posted on line and sent to unit managers.•Vaccination was promoted on screen savers throughout the hospital and with a telephone on-hold message.•A letter from the CEO was sent to employees to encourage vaccination.
•From September to December 1 2009, the seasonal influenza vaccination rate was 76.6% (4271/5578). Of these 67.5% received vaccination at UHS, 9.1% received vaccination from other providers. Among the 92.4% contacted, 82.9% (4147/5578) received vaccination and 863 (17.1%) declined vaccination.
In 2008, 58.8% vaccination rate
Institution Vaccine & Side Effects
LogisticsHard to contact everyone
Takes time to sway people back to acceptance
Education
Afraid of getting flu from vaccine
Misconception about live vaccine
Placebo effect
Previous experience, cold orother illness after vaccinated
Fear of side effectsLack of knowledge
All proceedings and records of the Quality/Risk Management Committee are confidential and all professional review actions and communications made to the Quality/Risk Management Committee are privileged under Texas and federal law.Tex. Occ. Code Ann. Chps 151 & 160; Tex Health And Safety Code § 161.032; and 42 U.S.C. 11101 § et seq.
Believe the vaccine is a guess
H1N1: How can they make it in 3 months when usually takes a whole year?
Lack of time
Not educated about flu
Egocentric individuals (only effect self)
Not enough facts
H1N1 Risk Population is changing
Lack of trust in peoplewho make vaccine
Not priority to be knowledgable about vaccine
TV always negative
Hard to overcome individual beliefs
Vocal people sway others
Only focuses on flu during flu season
Have never had the flu, so
not concerned
People
Object to putting substances in their body
Core belief Peer Pressure
Lack of interest
Past experience
Unit culture
Leadership
Lack of buy-in
Don’t give time to staff
Don’t believe
Don’t get it
Don’t encourage
Lack of interest by leader
Executive leadershipdoes not set example
Leader lacks leadership skills
Must go above and beyond
Lack of accountability
Lack of peer pressure at this level
No ramifications to leaderif staff not vaccinated
Lack audit/feedback
No ramifications to executiveleaders
Delay in shipments
Figure 1. Cause- Effect diagram describing the causes for the low rate of vaccination during the 2008-2009 Influenza season
Restraining Forces
UH management strongly suports the Employee Flu Vaccination Inititaive →
← People Factors: Staff donot believe in getting vaccinated due to religious causes, lack of trust, mortality, complications
Immunization Clinic well staffed, knowledgable, updated on vaccination information →
← Peer /Unit pressure to resist vaccination
→
← Lack of time, institution only focuses on flu during Flu season
Strong vaccination campaign →
← Lack of education: not enough facts
→
←
↓
These forces resulted in low employee flu vaccination
Force Field AnalysisGoal: To increase the Employee Seasonal Flu Vaccination Rate from 58% to 80 % by November 15th 2009, at University Hospital in San Antonio,TX
Driving Forces Current Employee Flu vaccination rate = 58%
•Concurrently, the process of vaccination was mapped using a process flow chart (Figure 3). With the use of force field analysis, the findings of the brainstorming session and the cause-effect diagram, interventions were planned to try to increase rate of vaccination, and a Gantt chart was developed to create a timeline for different interventions.
Figure 2. Force Field Analysis
Figure 3. Pre intervention Flow Diagram
The most common reasons for declination are presented on the Pareto Chart below (Figure 5)
Figure 4. Vaccination rates over intervention period
A QI team-based, interprofessional, and multidisciplinary approach including employee health, infection prevention, corporate communications, nursing, medical staff leadership, residency program leadership, and quality management was chartered by UHS leadership and met weekly to increase the rate of voluntary seasonal influenza vaccination. Employees were educated through multiple channels, including an influenza intranet website. Weekly dashboards on the website allowed unit directors to track vaccination rates by department. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the voluntary vaccination rate.
References1. Molinari NA, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007 Jun 28;25(27):5086-96.2.Salgado CD, et al. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004 Nov;25(11):923-8.3. Pearson ML, et al. Influenza vaccination of health-care personnel: recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006 Feb 24;55(RR-2):1-16.4. Caban-Martinez AJ, et al. Sustained low influenza vaccination rates in US healthcare workers. Prev Med Jan 15.5. Kohn KT CJ, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 1999.6.Leape LL, Berwick DM. Five years after To Err Is Human: what have we learned? JAMA 2005 May 18;293(19):2384-90.7.Hannah KL, Schade CP, Cochran R, Brehm JG. Promoting influenza and pneumococcal immunization in older adults. Jt Comm J Qual Patient Saf 2005 May;31(5):286-93.8. Nowalk MP, et al. Improving influenza vaccination rates in the workplace: a randomized trial. Am J Prev Med Mar;38(3):237-46.9.Stewart AM. Mandatory vaccination of health care workers. N Engl J Med 2009 Nov 19;361(21):2015-7.10. Loeb M et al. Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers A Randomized Trial . JAMA. 2009;302(17):1865-1871.
Background: Healthcare workers (HCW) with influenza may infect patients; transmissibility can begin one day before symptom onset and up to 50% of infections may be subclinical. Seasonal influenza vaccine is 70-90% effective in preventing infection in healthy adults and reduces absenteeism. ACIP, SHEA, and IDSA have recommended that all HCW be immunized. An 80% vaccination rate may provide “herd” immunity in a hospital setting. Previous seasonal influenza vaccination rates were < 60% for University Health System (UHS), a 600 bed tertiary care hospital with a solid organ transplant program, hematology oncology unit, 16 outpatient clinics, and ED with >70,000 visits per year.Objective: Use quality improvement (QI) tools to improve the employee seasonal influenza vaccination rate to 80% or more at UHS for the 2009-2010 influenza season.Methods: Prior flu vaccination rates were reviewed with the UHS Board, who supported universal voluntary vaccination of employees. A QI team including employee health, infection control, corporate communications, nursing, medical staff leadership, residency program leadership and quality management was chartered by UHS leadership and met weekly. QI tools used: brainstorming, force-field analysis, cause-effect diagram, process flow chart, dashboards, Pareto analysis and Gantt chart.Results: For the 2008-2009 season (Oct-March) prior to the intervention, the vaccination rate was 58.8% (2989/5496). Interventions included distribution of flu vaccine kits to UHS ward and clinic units, Grand Rounds presentations for major departments, campaign announcement to unit directors, development of a UHS influenza website with information and a flu blog, screensaver reminders, employee emails, and phone messages. A color-coded dashboard displaying vaccination rates by UHS department was posted on the UHS intranet. Beginning September 2009, 90% (5010 /5569) active UHS employees were contacted & returned an influenza vaccination form. Among those contacted, 83% (4147/5010) received vaccination and 863 (17%) declined. The most common reasons for declination were: fear of getting flu (126; 14.6%), side effects of vaccine (80; 9%) and doubt of effectiveness (63; 7%). Medical contraindication was uncommon (47; 5%) . After the QI team interventions (September-November 2009), the overall vaccination rate increased to 76.6%, (4271/5578) an 17.8% increase from the pre-intervention period (OR 2.7, 95% CI 2.5-2.97, p: <0.01). Conclusions: A QI team-based, interprofessional and multidisciplinary approach significantly increased the rate of seasonal vaccination. The interventions and increased availability of vaccines enhanced staff awareness. Weekly dashboards on the web site helped unit directors track vaccination rates. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the vaccination rate.
Figure 5. Pareto Chart for Employees not taking the Flu Vaccine at UHS
