ED Accreditation Update: Strengthened standards on flu vaccinations to pressure hospitals for progress
Strengthened standards on flu vaccinations to pressure hospitals for progress
Aggressive steps can deliver big results in a hurry
Despite recommendations from the Centers for Disease Control in Atlanta, GA, and many other public health authorities that all health care workers receive flu shots each year, there continues to be considerable resistance among the health care workers themselves. During last year's flu season, for example, the CDC estimates that only 63.5% of health care workers received the vaccination — only a slight increase over the 2009-2010 flu season when an estimated 61.9% of health care workers were vaccinated.
However, hospitals accredited by the Joint Commission, based in Oakbrook Terrace, IL, will not be able to get away with such paltry vaccination rates for long. Under revised guidelines that go into effect on July 1, 2012, hospitals will need to set incremental vaccination goals that get them to a 90% vaccination rate by 2020. Further, under the agency's revised standard IC.02.04.01, hospitals need to take the following steps, if they have not already done so:
- establish an annual influenza vaccination program that includes all staff and licensed independent practitioners;
- provide influenza vaccinations on site;
- monitor vaccination rates as well as the reasons why staff decline to be vaccinated;
- implement regular enhancements to the program to improve vaccination rates;
- provide education about influenza and its potential impact, including information about vaccination as well as other methods for controlling the spread of the virus.
Noting that 2020 is still eight years away, some experts advocated for stronger provisions, and there are reports that a federal government subcommittee that makes vaccination recommendations favors mandated flu vaccinations. However, through a spokesman, the Joint Commission noted that it wanted to "allow organizations the freedom to develop and implement an influenza vaccination program that will be effective in their culture."
Further, some nursing organizations are opposed to mandated vaccinations. "I think the focus should be on encouraging vaccinations, providing vaccinations, and education, but not mandating," explains Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, president of the Des Plaines, IL-based Emergency Nurses Association. "There are various risks and benefits to vaccinations, so while issuing a blanket mandate might be a popular thing to do with the public, I don't think it is ever a good idea."
Provide easy access to vaccinations
While it is clear from the statistics that many hospitals struggle with this issue, some organizations have already reached, and even exceeded, the Joint Commission's flu vaccination goals for 2020. For example, at Good Samaritan Hospital in San Jose, CA, 91.3% of all employees who come into contact with patients received flu vaccinations this year, explains Arthur Douville, MD, the hospital's chief medical officer.
How did the hospital accomplish this feat? By leveraging resources to make the vaccinations accessible and applying social pressure, says Douville. "We were not only telling employees that they would have to wear a mask if they didn't receive the influenza vaccination, but also making it easy for them to get the vaccination done," he explains.
The hospital had roving vaccination teams who went from department to department with carts, making the shots available to any employees who had not yet been vaccinated. "As long as I had RNs on workers' compensation light duty, I enlisted them to take the carts to the units and vaccinate hospital employees, doctors, and volunteers," says Carla Bentley, RN, COHN-S, the hospital's director of employee health. "They did this on all shifts, seven days a week. Nursing assistants on light duty provided administrative support."
Bentley adds that the hospital always tries to get the ED staff vaccinated first, but that they don't step up unless the vaccination carts are there, so accessibility is key. But she believes the most influential factor in the hospital's policy was the provision requiring all employees who refuse the vaccinations to sign a declination form and to wear a mask.
The vaccinations were offered to employees free of charge, and there was also plenty of information about the program available to employees who may have had questions about the policy or the shots, explains Linda Roquemore, OTR/L, CEAS, the hospital's director of employee safety. "We sent out notices and posters with flu education ahead of time, which gave everyone time to process and make an informed decision," she says. "With help from our HR department, we were able to set goals and timelines for compliance."
Make the commitment
During a three-month campaign, from October 2011 through December 2011, a flu coordinator reported weekly on how many employees had received their shots, and employees were given a firm deadline for when they had to either receive their flu vaccination or fill out the declination form explaining why they declined.
"The vast majority of employees see this as a safety issue. They see it as a way of not only protecting themselves, but also their patients, and they really respond to the responsibility," says Douville. "Everybody that gets a vaccination gets a little silver disk on their ID badge so that they can show that they were vaccinated."
Douville acknowledges that there are employees who have an allergy to eggs or another health-related reason why they should not receive the vaccine, but these employees are still required to wear a mask if they come within six feet of a patient and if they have a direct role in caring for patients, he says.
The hospital's parent company, Nashville, TN-based HCA (Hospital Corporation of America), took the lead on the flu vaccination initiative, making funding available for the vaccinations, as well as staffing to support the initiative, says Douville. Not all hospitals have access to those resources, but Douville stresses that there should still be an organizational commitment to make headway on this issue. "I don't understand why a hospital can accept a 60% or 70% flu vaccination rate," he says. "It doesn't have the herd immunity effect that you need to actually reduce the likelihood of the spread of the virus in a health care institution."
Sources
- Carla Bentley, RN, COHN-S, Director of Employee Health, Good Samaritan Hospital, San Jose, CA. E-mail: [email protected].
- Arthur Douville, MD, Chief Medical Officer, Good Samaritan Hospital, San Jose, CA. E-mail: [email protected].
- Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, President, Emergency Nurses Association, Des Plaines, IL. E-mail: [email protected].
- Linda Roquemore, OTR/L, CEAS, Director of Employee Safety, Good Samaritan Hospital, San Jose, CA. E-mail: [email protected].
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