Who’s in charge?

Or, rather, what’s the best way to increase flu vaccination rates among employees?

Does it matter who is running the show, as long as the task at hand is completed? About 10 years ago, as part of the Raising Immunizations Safely and Effectively (RISE) program, 14 long-term-care facilities ceded control of vaccination-related policies and processes to a regional pharmacy, according to the Agency for Healthcare Research and Quality (AHRQ). The facilities have since collaborated with the pharmacy, RxPartners Inc., to implement and enforce standardized policies to increase influenza vaccine rates among facility workers. The results, notes the agency, have been positive. “The policy change significantly increased worker vaccination rates in participating facilities, enabling all facilities to reach the Centers for Disease Control and Prevention (CDC) Healthy People 2010 goal of vaccinating 60 percent of workers in long-term-care settings and several facilities to exceed the Healthy People 2020 goal of vaccinating 90 percent.”

Addressing the issue
The CDC set its Healthy People goals to address the issue of influenza-infected workers in long-term care settings spreading the disease to elderly and immune-compromised residents. Vaccination rates likely have remained well below these goals because high staff turnover reduces adherence to facility policies, AHRQ speculates. While regional and national pharmacies within long-term care facilities are in a position to help promote adherence, few currently play that role.

The 14 facilities participating in RISE have been collaborating with RxPartners to implement and enforce standardized policies to increase influenza vaccination rates among their facility workers as follows, according to AHRQ:

Agreement to transfer vaccination-related policies to regional pharmacy. Prior to implementation of the program, each of the 14 long-term-care facilities had its own vaccination policies (stated in its policy and procedure manual) for residents and workers. Under the new approach, the facilities ceded control of all immunization policies and procedures related to residents, workers and the management of outbreaks, and transferred them to RxPartners Inc. Also, in keeping with a CMS 2002 directive, which states that pneumococcal and influenza vaccinations may be administered without a physician order, the 14 facilities do not require a physician order to administer the vaccine to their workers.

• Abide by standing order. RxPartners’s medical director approves its policies and procedures, creating a standing order that applies to the administration of influenza vaccination.
• Eliminate consent form. The 14 facilities agree to eliminate the requirement that those receiving the influenza vaccination sign a consent form, which can be lengthy and detail potential problems associated with the vaccine, and reportedly has been a barrier to workers being immunized.
• Require declination form. The facilities must require workers electing not to be vaccinated to sign a declination form that states the risks of foregoing vaccination, including the risk of spreading the disease.
• Offer convenient vaccines, at no cost, to workers on all shifts.
• Designate a local champion. Each facility must assign an individual to work with the pharmacy staff to boost immunization rates among workers and oversee related on-site issues, such as monitoring vaccine supply and maintaining records to be submitted to the pharmacy.

Regional pharmacy support before and during flu season. RxPartners works with the designated champion at each facility to oversee the following:

• Distribution of educational materials, including a training video.
• In-service training.
• Annual campaign at each facility. Each year, the pharmacy staff and facility champion announce a kickoff date to begin the worker immunization campaign and arrange the provision of vaccines at all shifts, at an accessible location.
• Performance monitoring and feedback. RxPartners utilizes data submitted by the facility champions to track worker immunization rates and provide regular feedback on each facility’s performance.
• Regular e-mail communications with each facility.

Based on data from recent flu seasons, it appears that the program has been successful. During the first flu season (2005-2006) following implementation of RISE, immunization rates averaged 58 percent across the 14 participating facilities – well above the 40-50 percent average recorded over a three-year period preceding the program. Rates have increased steadily since that time, according to AHRQ, rising to 76 percent during the 2010-2011 flu season, and remaining close to that during the 2011-2012 season.

It’s a goal AHRQ considers worth continuing to pursue, particularly given that during the four-year period preceding implementation, only one of the 14 facilities ever reached the Healthy People 2010 goal of immunizing 60 percent of workers, and the facility did so only one year. Just as noteworthy, the implementation of RISE has required no new staff and costs have been limited to minimal printing expenses and distribution of educational materials. The annual cost of immunizing the 50-400 employees at each of the 14 facilities? Approximately $1,000 per facility.