Kristy Cottrell, MPA RN Senior Services Director Health Department Deputy Director. Shawna Mahan, SSW Bureau Manager, HCBS Senior Services

Transcription

1 Kristy Cottrell, MPA RN Senior Services Director Health Department Deputy Director Shawna Mahan, SSW Bureau Manager, HCBS Senior Services Davis County Health Department

2 advocacy noun ad vo ca cy \ˈad-və-kə-sē\ the act or process of supporting a cause or proposal : the act or process of advocating something Source: Merriam-Webster's Learner's Dictionary

3 policy noun, often attributive pol i cy \ˈpä-lə-sē\ 1 a : prudence or wisdom in the management of affairs b : management or procedure based primarily on material interest 2a : a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions b : a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body Source: Merriam-Webster's Dictionary

4 Legal Definition of Policy an overall plan, principle, or guideline; especially one formulated outside of the judiciary. Source: Merriam-Webster.com

5 Influenza Vaccine Recommendations ALL HCP, including those with no direct patient contact Need for comprehensive programs to increase vaccine coverage Regular reporting and measurement of HCP vaccination rates is needed

6 United States Health Care Employees and Influenza Vaccination Source:

7 What is the flu? It is not a cold and it is not a stomach illness Flu comes on suddenly, most people feel like a truck hit them Fever / chills Cough Sore throat Runny or stuffy nose Headaches Fatigue Some people may have vomiting and diarrhea, although more common in children

8 Complications: Can be life-threatening and result in death. Pneumonia Bronchitis Sinus and ear infections Influenza can make chronic health problems worse.

9 (National Library of Medicine) Protecting the Vulnerable High-risk populations Seniors People with certain chronic conditions Asthma Diabetes Heart Disease Lung Disease Pregnant Women Young Children

10

11 LTC Employees LTC Residents

12 Increased Insurance Utilization Sick days & staffing shortages- Decreased quality of care Working while sick - Presenteeism Sick Employees=$$

13 2010 Davis County, Utah Davis County, Utah LTC Facilities 56.8% 2010 Utah LTC Facilities 46.8% Hospitals 86.1%

14 The Policy Hospitals Utah Administrative Rule requires hospitals to annually report HCW influenza vaccination rates. LTC Facilities Utah Administrative requires LTC facilities to annually report employee influenza vaccination rates. Utah Healthcare Infection Prevention Governance Committee recommends facilities implement compulsory vaccination unless facility achieved 95% rates through other means. Utah Administrative Rule requires LTC facilities to implement policies and procedures protecting patients and residents from vaccine preventable illnesses.

15 Policy recommends compulsory vaccinations, unless achieving 95% rate Hospitals report HCP data Annual published report, includes facility name and rate

16 LTC Facilities report employee vaccine data Policy recommendationimplement a procedure to protect patients Annual rates aggregate report, county and state levels

17 What we did- The team AAA Director Local Health Department (LHD) Nursing Director Immunization Coordinator Public Health Nurses Ombudsman AAA program managers Case Managers

18 LTC HCP 8 Skilled Nursing Facilities Focus Groups Focus groups assessed attitudes, barriers and solutions among facility administrators and key stakeholders.

19

20 Integrative approach Pairing AAA staff/hd staff Site visits Long-term care facilities Assisted Living Facilities

21

22

23 Best Practices Staff education Employer pays for vaccination Make it easy! On-site Available during alternative hours for shift change, and PRN staff Management Support and encouragement Declination Forms

24 Drafted and distributed a model employee vaccination policy Declinations handled formally in-house, or at the local health department.

25 Protecting the Vulnerable Declination of Influenza Vaccination My employer or affiliated facility, is requiring that I receive influenza vaccination in order to protect myself and the patients I serve. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease that kills an average of 36,000 persons and hospitalizes more than 200,000 persons in the United States each year. Influenza vaccination is recommended for me and all other healthcare workers to prevent influenza disease and its complications, including death. If I contract influenza, I will shed the virus for hours before influenza symptoms appear. My shedding the virus can spread influenza infection to patients in this facility. If I become infected with influenza, even when my symptoms are mild, I can spread severe illness to others. I understand that the strains of the virus that cause influenza infection change almost every year, which is why a different influenza vaccine is recommended each year. I cannot get the influenza disease from the influenza vaccine The consequences of my refusing to be vaccinated could endanger my health and the health of those with whom I have contact, including Patients in this healthcare setting My co-workers My family My community Despite these facts, I am DECLINING influenza vaccination. I understand that I may change my mind at any time and accept influenza vaccination, if vaccine is available. I understand that in case of an outbreak, I will be required to use face masks, and I may not be able to work. Time off will be taken without compensation according to agency policy. I have read and fully understand the information on this declination form. I have had the opportunity to have my questions answered. Signature: Date: Name: Reason: Explanation: Declination Education Provided By: Department: Title:

26

27 Provided periodic influenza vaccination messaging to LTC facility administrators and nursing directors.

28

29

30 2014- conducted site visits to larger facilities with low rates, offering education, support, and if needed, on-site vaccination.

31

32

33 2015 Meanwhile hospitals did it on their own. Compulsory letter Healthcare infection committee to LTC facilities

34 Hospitals LTC Facilities Utah LTC Facilities Davis County % 46.8% 56.8% % 63.6% 75.9% % 61.7% 65.9%

35 Discussion LTC facilities implementing the model policy achieved greater success, although this was not always sustained over time. Employee turnover remains a significant barrier. Nationally in 2012, LTC facilities experienced a 43.9% median turnover rate. RNs and CNAs turnover rates of 50% and 51.5% increased from 2011 (American Health Care Association, 2014).

36 Next Steps 2015, Davis County Health Officer worked with the Utah Health Facilities Committee to promote and implement a statewide policy change requiring annual influenza vaccination for LTC employees. Drafted proposed rule statutory language is currently awaiting full committee consideration to advance this rule change and policy implementation Still waiting.

37 2014 Publication

38

39

40 Next Steps Spring/Summer 2017 Expect Published list of LTC facility rates, by name of facility

41 Next Steps Advocacy? Policy?

42

43 Influenza Vaccination and the Long-Term Care Employee 2010, only 56.8% of Davis County LTC employees received annual influenza vaccination Increas ed Insuran ce Utilizat ion Sick days & staffing shortages- Decreased quality of care Working while sick - Presenteeis m Sick Employees = $$ Annual influenza vaccination continues to be an efficient approach preventing disease outbreaks resulting in morbidity and mortality. Older adults and people with chronic health conditions suffer greater complications from influenza, including death. Vulnerable populations residing at long-term care (LTC) facilities deserve a decreased chance of disease exposure through the presence of vaccinated employees. Flu Vaccination & Davis County LTC Employees 63.0% 66.3% 70.0% 75.9% 56.8% 85.0% Flu Flu Vaccination Vaccination & Hospital Utah LTC Employees Employees 96.6% 96.7% 63.6% Utah Code R432 requires influenza vaccine availability for LTC facility employees and to annually report the number vaccinated. Strategies Conducted focus groups assessing attitudes, barriers and solutions among facility administrators and key stakeholders. Drafted model employee vaccination policy, with declinations handled formally, either in-house or at the local health department. Provided periodic influenza vaccination messaging to LTC facility administrators and nursing directors conducted site visits to larger facilities with low rates, offering education, support, and if needed, on-site vaccination. Provided achievement certificates to all facilities with 90% rates or better, and those demonstrating significant improvement. Annual rates assessed utilizing the UDOH Immunization Program LTC employee vaccination reports. Discussion Goal2014 Utah LTC LTC facilities implementing the model policy achieved greater success, although this was not always sustained over time. Employee turnover remains a significant barrier. Nationally in 2012, LTC facilities experienced a 43.9% median turnover rate. RNs and CNAs turnover rates of 50% and 51.5% increased from 2011 (American Health Care Association, 2014). Personal beliefs and attitudes significantly impact agency and employee compliance. Onsite support and education can positively impact this area. Next Steps 2014 Davis Hospitals 2014 Utah Hospitals The Davis County Health Officer is working with the Utah Health Facilities Committee to promote and implement a statewide policy change requiring annual influenza vaccination for LTC employees. Drafted proposed rule statutory language is currently awaiting full committee consideration to advance this rule change and policy implementation. Further research is needed to determine reasons behind sustained facility success in vaccinating employees, and applicability to replicate throughout the county.