Flu campaign goes beyond the mandate

Virginia Mason uses incentives, options

Almost everyone gets the flu shot at Virginia Mason Medical Center in Seattle. It isn't an option. It's a condition of employment.

But the hospital still works hard to spice up its annual flu vaccine campaign with other options, incentives, education, and innovative approaches. There's more to the mandatory vaccine than the mandate.

"You have to continuously educate and promote [the vaccine] and work with staff," says Beverly Hagar, BSN, COHN-S, employee health manager. "It's definitely a year-long campaign."

The Virginia Mason flu team includes representatives from employee health, human resources, inpatient nursing, pharmacy, asthma and allergy, infectious disease, and communications, as well as legal and other management staff.

The campaign slogan, "Save Lives, Immunize," was chosen from employee suggestions as part of a promotional campaign in 2005. This year, employees received a lanyard with the slogan when they got their flu shot.

The flu vaccine "kick-off" began with a tailgate party featuring football players and cheerleaders from the Seattle Seahawks. In a room adorned with Seahawk posters and paraphernalia, the football players were among the first to get their vaccine — followed by about 750 employees.

Nurses wore Seahawks jerseys as they vaccinated employees at six stations, and the party atmosphere included music, hotdogs and chips, and prizes.

The hospital then launched its "Double Shot" promotion. Hospitals (and patients) could get their flu shots from drive-through stations. As a bonus, they also received a shot of espresso.

Within a month, the hospital had already vaccinated 78% of its employees.

Moving beyond the controversy

The mandatory flu vaccine policy has brought both acclaim and controversy to Virginia Mason.

The Washington State Nurses Association argued that the policy violated nurses' rights to bargain over their working conditions. A U.S. district court judge agreed, and the vaccine is optional for those inpatient unionized nurses. However, last fall, an administrative law judge ruled that the hospital could require nurses to wear masks in patient care areas for infection control during the influenza season.

"We take an oath: 'First, do no harm,'" says Greg Poland, MD, a flu vaccine expert and director of the Mayo Vaccine Research Group at the Mayo Medical School of the Mayo Clinic and Foundation, who has been outspoken in favor of mandatory vaccination of health care workers. "This is a patient safety issue."

In this flu vaccine campaign, Virginia Mason employees were required to receive their flu vaccine by Dec. 13 or begin wearing masks and face possible termination. Those with documented medical contraindications such as allergies or religious objections must wear masks during the flu season and may be asked to take antiviral medications during a flu outbreak. Nurses who choose not to receive the vaccine also must wear masks.

Virginia Mason vaccinated 98% of its employees in the 2005-2006 flu season — 4,504 of 4,588 employees. Most nurses received the vaccine despite the dispute: 515 of 599, or 86%, were immunized. Thirty-one employees received an accommodation and seven were terminated.

In the 2006-2007 flu season, more than 98% have been vaccinated. "The organization has reached a 100% fitness for duty, combining influenza immunization and masking," says spokeswoman Kim Davis. Before establishing the mandatory policy, the hospital's highest rate of vaccination was 55%.

"As an organization, we're proud that we were the first to implement this," says Hagar. "It wasn't easy to implement. We had to face a lot of hurdles. We definitely had administrative support, and they were forward-thinking in moving on this initiative."

Coping with logistic challenges

The logistics of vaccinating some 5,000 employees within six weeks is daunting for the employee health staff of two full-time nurses and an administrative assistant. They received support from light-duty nurses and flu "champions" on units. In a "peer vaccination" program, nurses who received training from employee health provided vaccinations to their co-workers in their units.

Every shot administered at the hospital generated two copies of documentation — one for the employee to keep and one to be entered into the Oracle database.

Physicians were required to receive vaccines as a condition of their credentialing, and vendors had to demonstrate proof of vaccination to receive a badge allowing them on campus. Volunteers, students, and contracted service workers, such as the housekeeping staff, were also required to receive the vaccine.

In 2005, the hospital conducted educational forums and answered staff questions. Poland spoke to physicians at grand rounds.

Education has been a key part of the program to combat common myths about the vaccine. In the first year of implementation, as part of an education blitz, employees could answer flu quiz questions to enter a drawing for prizes. Meanwhile, those who delayed getting their flu shot were required to view a computer training module.

This year, educational materials remain on the hospital's web site, and new employees are informed of the policy and its purpose. "It's becoming part of the hospital culture," says Hagar. "It flows right into our culture of safety."