Pennsylvania Health Care Worker Flu Immunization

CampaignA Patient Safety & Employee Health Initiative

Training Resources:Cast Study Module: HUP

Version 1.1June 2011

Case Study Modules

Based on interviews with leaders at institutions representing best and promising practices

Focus on common elements of strategy, decision to implement programs, internal support and barriers

Focus on mandatory programs given policy and ethics foundations

Recognition that each institution is unique, but overall goal (90%+ uptake) is patient safety/ employee safety imperative is same everywhere!

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

The Hospital of the University of Pennsylvania (HUP) is world-renowned for its clinical and research excellence, forging the way for newer and better ways to diagnose and treat illnesses and disorders. Its long and rich history of top-notch patient care began more than two centuries ago with the founding of the nation’s first medical school, the University of Pennsylvania. Since 1765 when it first opened its doors, Penn has been dedicated to the training of physicians and the discovery and implementation of new medical knowledge...The supportive and collaborative environment encourages physicians and staff to keep reaching ahead to find new ways to improve the quality and length of life for everyone. http://www.pennmedicine.org/hup/about/

Contacts:Amy Behrman, MDDirector, Occupational Medicine427 Penn TowerHospital of the University of PennsylvaniaPhiladelphia, PA   19104215-662-3192Amy.Behrman@uphs.upenn.edu

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

OverviewAfter robust seasonal vaccine campaigns for its HCWs over several years, HUP decided to adopt a mandated program after extensive consultation across medical, nursing and administrative leadership. 

  Seasonal Influenza Vaccine Uptake

Pre-mandate                                   Post-Mandate

≈ 54%*                             99.3%2008-09 (60% of clinical staff)                    plus 0.6% exemptions

for HUP

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Program JustificationPositioned as a patient safety/staff safety initiative

Program Details- establishes annual seasonal flu vaccination as a condition of employment- includes all employees, volunteers, students, vendors- includes faculty, physicians and clinical staff from UPenn- integrates exemptions based on standard form: medical – reviewed by the OH Director with backup from Infection Control Director; religious – reviewed by HR officer: 1-2% incidence rate

Key Champion(s)- PJ Brennan, CMO- Infection Control and Occupation Health- Nursing/CNO- HR/Legal

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Timeline2004+- Influenza vaccination as a quality focus beginsSpring  2009:- HUP IM/EM physician survey spring 2009 supported a mandatory vaccine policy (DeSante et al 2010)- Review of program outcomes for 2008-2009 . 4th consecutive year of increased vaccination rates but only modest gains with great efforts at outreach- Infection Control and Occupational Medicine consensus on need for requiring vaccination . Nursing leadership support for mandate . Physician leadership support for mandate . HR leadership support for mandate . OGC (Office of General Counsel/Law) support for mandate

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Timeline cont.Fall 2009/Winter 2010:- Required influenza vaccination for all HCWs supported by . Educational programs, website . Interactive live and electronic Q&A . Exemption reviews, medical and religious . Continued multi-faceted outreach to all staff @ all locations

Fall 2010/Winter 2011- Second cycle with stable performance at 99%+ uptake with stable exemptions

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Key Strategies/Success Factors- Define target population early, announce clearly

- Assure robust tracking system, and ability internal reports for local manager action/follow-up

- Have plan for interrupted vaccine supply/triage plan

- Develop detailed exemption review process

- Develop policies around verifying outside vaccination/documentation levels

- “Stickers” verifying vaccination status a matter of pride (red dot/blue dot)

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Best sound bite(s)PJ Brennan, CMO, went around table at Medical Board meeting:Q: Will you withdraw privileges to docs who are non-compliant with the influenza vaccination mandate?A. Unanimous “yes”

Leadership Team (functions that made it happen)Occupational MedicineInfection ControlHR, LawNursing Administration

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

Program Overview: 2004-2009- Free vaccine available to all HCWs T/O Flu season- Vaccination on-site in all inpatient units, clinics and non-clinical sites, offered all shifts- Vaccine given to employees at cafeteria- Vaccine in public hospital areas via  “Flu fairs” with educational materials, games, and incentives- Vaccine available on a walk-in basis in the OM clinic 8-12 hours/day.- Needle-free FluMist provided for medically eligible staff who preferred it.- Declination forms analyzed to define HCW concerns- Influenza vaccine education via hospital newsletter, email, intranet, KL, and managers’ meetings.- Flu shot music video using hospital staff to address concerns about vaccine safety and efficacy based on previous declination forms: http://www.youtube.com/watch?v=ruGgZbAVnko

Case Study SnapshotHospital of the University of Pennsylvania (HUP)

HUP IM/EM Physician survey spring 2009 supported a mandatory vaccine policy (DeSante et al 2010)- 90% believed HCWs have an obligation to their patients to be vaccinated

- 85% believed HCW vaccination should be mandatory

- Those with more patient contact were more likely to be vaccinated, more likely to support mandates, and more likely to vaccinate their patients

MANDATORY VACCINATIONS FOR HEALTHCARE WORKERS - THE VIEW FROM OCCUPATIONAL MEDICINE Amy J. Behrman, MD, Division of Occupational Medicine. Department of Emergency Medicine, University of Pennsylvania

MANDATORY VACCINATIONS FOR HEALTHCARE WORKERS - THE VIEW FROM OCCUPATIONAL MEDICINE Amy J. Behrman, MD, Division of Occupational Medicine. Department of Emergency Medicine, University of Pennsylvania

Group Exercise

What strategies from the HUP case study might work well in your institution? Why?

What parts of the HUP experience would NOT work for your institution? Why?

What barriers do you see within your institution moving towards a mandatory program?

Which barriers are not addressed in the HUP experience?

We will use observations and answers to build a collection of “frequently-asked-questions” (FAQs) for the website