QUALITY IMPROVEMENT REPORT

A quality improvement project to increase influenza vaccination in healthcare personnel at a university health center Ying Mai Kung, DNP, MN, MPH, FNP-BC (Associate-In-Nursing Faculty) College of Nursing, Florida State University, Tallahassee, Florida

Keywords Influenza; healthcare personnel; vaccination; immunization; quality improvement; advanced practice nurses. Correspondence Ying Mai Kung, DNP, MN, MPH, FNP-BC, College of Nursing, Florida State University, 443 Vivian M. Duxbury Hall, 98 Varsity Way, P.O. Box 3064310, Tallahassee, FL 32306-4310. Tel: 850-644-5105; Fax: 850-644-7660; E-mail: [email protected] Received: March 2012; accepted: July 2012 doi: 10.1002/2327-6924.12060

Abstract Purpose: The purpose of this quality improvement project was to increase the healthcare personnel (HCP) influenza vaccine uptake at a university student health center. Data sources: A descriptive design was used. A preintervention survey identified facilitators and barriers to HCP’s uptake of influenza vaccine. Based on the results of this survey, four interventions were implemented. The postintervention survey was administered to assess for intervention effectiveness. Conclusions: The most common facilitators for influenza vaccination uptake on the preintervention survey were as follows: (a) protect self/family, (b) free vaccine, (c) recommended by experts, and (d) convenient vaccination process. The most common barrier was concern about vaccine side effects. Postintervention, the vaccination uptake increased from 71% in 2008–2009 to 77% in 2009–2010. Free vaccine and convenient vaccination process were rated as the most effective interventions. Education and the declination form used for the project were rated less favorably. Implications for practice: Factors influencing vaccine uptake may be different across practice settings. It is important to identify facilitators and barriers that are unique to health centers to better plan and implement interventions to improve vaccination rates. Furthermore, at a time when resources are limited, it is critical to identify the most effective strategies to maximize outcomes.

Influenza is a common viral infection that may be transmitted before the onset of symptoms and is easily transmitted from person to person through respiratory droplets (Centers for Disease Control and Prevention [CDC], 2009). It is estimated that influenza affects 5%–20% of the population, which results in more than 200,000 hospitalizations and between 3000 and 49,000 deaths per year (CDC, 2009; Thompson et al., 2010). The influenza vaccination is safe and considered the most effective way to prevent influenza (CDC, 2011; Fiore et al., 2010; Nichol et al., 1999; Wilde et al., 1999). The CDC, the U.S. Department of Health and Human Services (HHS), and many other healthcare agencies and professional organizations recommend an annual influenza vaccination for all healthcare personnel (HCP) because they are a high-risk population for acquiring influenza from infected patients and can transmit the disease to their patients, co-workers, and families (American Medical Association, 2012; American Nurses

148

Association, n.d.; HHS, n.d.; National Foundation for Infectious Diseases, 2007; National Influenza Vaccine Summit [NIVS], 2012; National Vaccine Advisory Committee, 2012; Pearson, Bridges, & Harper, 2006). One randomized controlled trial noted 7%–26% of unvaccinated HCP had serologic evidence of influenza infection, and 42% could not recall having a febrile respiratory illness (Wilde et al., 1999). Another study that surveyed nurses in a large tertiary medical center found 78% of respondents reported having an influenza-like illness in the past year, and 80% of those worked while ill (Talbot, 2008). Christi, Shutt, and Byers (2007) reported that vaccinated hospital HCP were less likely to report influenzalike illness than unvaccinated workers. Salgado, Giannetta, Hayden, and Farr (2004) found in one hospital where the influenza vaccination rate increased from 4% to 67% over a 12-year period that laboratory-confirmed influenza cases among HCP were reduced from 42% to 9%. Furthermore, nosocomial influenza cases of

C 2013 The Author(s) Journal of the American Association of Nurse Practitioners 26 (2014) 148–154   C 2013 American Association of Nurse Practitioners

A quality improvement project to increase influenza vaccination

Y. M. Kung

Table 1 Evidence-based interventions to improve influenza vaccination uptake in healthcare personnel (HCP) Categorya IA

b

IBc IB

IB IId II

Recommendation Offering influenza vaccine annually to all eligible HCP using either trivalent influenza vaccine or live-attenuated influenza vaccine. Educating HCP on the benefits of influenza vaccination and the risks/sequelae associated with influenza illness. Providing influenza vaccination at the worksite to HCP at no cost to employees and employing strategies such as vaccination clinics, mobile carts, vaccination access during all work shifts, and modeling and support by institutional leaders. Monitoring HCP influenza vaccination and declination at regular intervals and provide feedback to staff. Obtaining signed declination forms from HCP who decline vaccination. Using HCP vaccination rates as an indicator for healthcare quality and safety.

Note. Adapted from Pearson et al. (2006). a Categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact. b Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies. c Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretic rationale. d Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretic rationale.

hospitalized patients decreased from 32% to zero. Hayward et al. (2006) conducted a study in nursing home settings and estimated that eight staff vaccinations can prevent one death; five staff vaccinations may prevent one influenza-like illness; six staff vaccinations can avoid one general practitioner consultation for influenza-like illness; and 20 staff vaccinations may prevent one admission to hospital with influenza-like illness. The Healthy People 2020 objective (IID-12.9) on influenza vaccination for all who work in health care is targeted at 90% (Healthy People 2012). Even though the HCP vaccination rate has improved over the years from

A quality improvement project to increase influenza vaccination in healthcare personnel at a university health center.

The purpose of this quality improvement project was to increase the healthcare personnel (HCP) influenza vaccine uptake at a university student health...
117KB Sizes 0 Downloads 0 Views