LeadingAge Magazine · September/October 2015 • Volume 05 • Number 05

Achieving High Compliance With an Associate Influenza Vaccination Program

September 13, 2015 | by Mary Woloski, R.N.

This provider’s flu shot program for associates succeeded with a combination of new policies and coordinated education for all staff.

Westminster-Canterbury of the Blue Ridge, Charlottesville, VA, implemented a highly successful influenza vaccination program for associates in the 2014-2015 flu season, achieving a 99% vaccination rate.

We had been closely tracking associate flu shot compliance for the last two years. The 2012-2013 flu season saw 66.9% compliance (Figure 1) and the 2013-2014 flu season saw 73.5% compliance (Figure 2). Despite considerable effort at education and flu vaccine availability, there remained a high number of associates refusing the influenza vaccine (approximately 25%, or 75 associates in the 2013-2014 flu season).

We revised our associate handbooks, making influenza immunization a condition of employment. We also revised the Associate Influenza Policy.

From associates who refused vaccination for medical or religious reasons, we required valid documentation of those reasons. These associates were to wear a surgical mask while on campus and throughout the flu season.

We ordered individually dosed inactivated quadrivalent influenza vaccine, which had the added benefit of being preservative-free. We also ordered 10 doses of trivalent cell culture-based inactivated influenza vaccine and 10 doses of trivalent inactivated intradermal vaccine.

Our Associate Consent (or Declination) for Influenza Vaccination form helped us track associates’ flu choice responses. The form offers four options:

1. Obtaining the flu shot at the workplace
2. Obtaining the flu shot elsewhere
3. Refusing for medical reasons
4. Refusing for religious reasons

Our online education program was used to track associates completing the form. The infection control nurse received copies of the forms and was responsible for tracking the data.

Education and communication between the infection control nurse and the management team was paramount. A double-sided, 1-page information sheet was provided to all managers and supervisors to assist them in promoting the associate influenza program.

We held education sessions (with prizes for flu shot participation), and provided individual counseling as well. A hallway display addressed myths and barriers to influenza vaccine, and offered prizes for answering 10 “Questions of the Day” for a 2-week period.

The influenza vaccine was available to all associates throughout the flu season via various flu shot sessions, a traveling flu shot cart, during the clinic operating hours and in all the care areas. The deadline for compliance was Nov. 30th, 2014.

Our associate influenza vaccination policy, along with the support of the administration, including all senior managers, supervisors and head nurses, was instrumental in obtaining successful results. The support and encouragement of both the CEO/president and the medical director, as well as the efforts of the infection control nurse, were crucial.

We achieved a 99% success rate (Figure 3). Only 3 associates out of 311 refused the influenza vaccine, based on appropriately documented medical reasons; they wore surgical masks through the entire flu season. No associates refused the vaccine for religious reasons. There was 100% compliance in completing the Associate Consent (or Declination) for Influenza Vaccination form. There were no terminations as a result of the policy nor were there associates who left as a result of the policy. All new hires throughout the flu season were compliant with the policy.

Our resident influenza vaccination rates were also quite high. Vaccine information sheets and consent forms are provided to family and/or residents in September. Large influenza vaccination flu sessions were organized for independent living residents and advertised throughout the campus. Residents were also involved in tracking attendance. Notices were posted throughout the campus.

The results were impressive. We achieved a 100% vaccination rate in the health center (nursing home), 88.2% in Catered Living (assisted living) and 100% in Vista (our dementia unit). About 95% compliance was achieved in the independent living areas. Six residents refused and nine could not be contacted.

Our influenza vaccination campaign was well orchestrated, with many committed to the outcome. Literature supports the idea of such a flu shot campaign with consequences, as voluntary action has proven to be insufficient and has failed. Associate influenza vaccination is a responsibility of both health care institutions and health care professionals and is especially important in the long-term care arena. Indeed, associate influenza vaccination may very well be seen as a measure of quality of care in the future.