Community vaccination: More than good health

The benefits come in many different forms

Operating a community flu clinic is a good way to make sure your home health agency’s name is associated with good will in the community, says Susan R. McCarter, RN, community educator for Diversified Home Health Services in Towson, MD.

Every year, McCarter’s agency vaccinates between 5,000 and 6,000 people within the Baltimore area. "We have a contract with the Baltimore Services for the Aging to provide community clinics at their annual service fair and at senior centers throughout the area," she says.

"We do use standing orders for the community clinics, and the orders address administration of the vaccines as well as epinephrine, if needed," McCarter says. Because the clinics cover such a wide area of the agency’s market, McCarter’s nurses invite home health patients to the clinics rather than vaccinating them during regular home visits.

"The nurses hand out flyers to all of our home health patients, and if the patient cannot easily ambulate into the clinic area, we send a nurse out to the car to give the vaccination," she says.

Making vaccinations accessible

A special parking area directly in front of the senior citizen center doorway is designated for the drive-up patients.

"If they are receiving either vaccine for the first time, we ask their caregivers to stay in the parking area for 15 minutes, then a nurse checks on them before they leave," McCarter adds.

In Lafayette, IN, all of the flu clinic patients stay in their cars, says Janet Van Buskirk, branch manager of Preferred Home Health in Lafayette.

"We vaccinate our home care patients in their homes, using orders from their physicians, but we use standing orders to cover our drive-through clinic," she says.

This year, she and her staff vaccinated just less than 1,700 in one day, she says.

Both McCarter and Van Buskirk admit that a community flu clinic is a great way to make sure your agency’s name is familiar in the community, but McCarter also looks at the clinics as good for staff retention and even recruitment.

"Every year I recruit a group of nurses who work during October and November giving flu and pneumonia vaccinations," McCarter says. "A lot of my staff nurses want to work the clinics, even if it means extra hours, because they enjoy the break in routine," she says.

"Home health nursing is so intense, and you are often working with very ill patients," she points out. The clinics give nurses a chance to work with well patients in a very social setting, she explains. "All of my nurses say they look forward to the clinics," she adds.

This year, in addition to her regular network of hospital, physician office, and retired nurses who wanted to work the clinics, McCarter had an influx of graduate school-level nurses who signed up to work.

"I have two staff nurses who are working on their graduate degrees at two different universities, and they each notified their classmates about this opportunity," she says.

"Because students can only work a few days a week and still attend classes, many of their classmates applied for the positions because it fit their schedules," she explains.

Although she doesn’t know if any of the students will apply for positions in home health, McCarter says that she feels positive that their exposure to her agency and the services they provide will keep Diversified Home Health in their minds as they consider their career or offer advice to others.

Agency managers planning community clinics have to decide if they will use vials of vaccine or pre-filled syringes. "I recommend pre-filled syringes for large clinics because you have to spend money on extra staff to draw from the vials," Van Buskirk says.

McCarter would prefer the pre-filled syringes but says that the cost is prohibitive for her program. "We do bill Medicare, and we do charge non-Medicare patients a fee for their shot; but the reimbursement just barely covers costs," she says. Luckily, she does not have trouble recruiting enough staff to handle the vials, she adds.

Plan ahead

It is important to plan community flu and pneumonia clinics well in advance, McCarter says.

"It is unbelievable how many people will show up," she says. "You have to make sure you have enough consent forms, educational information about potential complications, staff, and vaccine," she says.

"We use a NCR form that includes the list of contraindications, potential complications, and consent all together," McCarter says. "We give one copy to the patient to keep or to pass along to their physician," she explains. "Then we have a billing table at which volunteers collect billing information for Medicare patients for whom we submit a roster billing and at which payment is collected for other people," McCarter says.

While McCarter and Van Buskirk do not pre-register flu clinic patients, the Chesapeake Potomac Home Health Agency does.

"We use space donated to us by the three hospitals that own us, so we need to be very organized and efficient so we don’t interfere with hospital operations," says Jill Bodamer RN, BSN, quality improvement and education coordinator for the Hughesville, MD, agency.

"We do take walk-ins, but we take pre-registrations by telephone prior to the clinic," she says. Pre-registration also enables her to better plan the supplies, forms, and staff that will be needed, she adds.

If you plan to offer the pneumonia vaccine as part of your community clinic, McCarter suggests that you not rely upon the memory of the patients as to when they last had their vaccination.

"We only give the pneumonia vaccine if the patients say they have never had one," McCarter says.

"Because the vaccine should not be given except every five years, I don’t want to take a chance that the patient received one six months ago, or one year ago," she says.