Vaccination not just for kids anymore. Karen Foren Lake, PhD, RNC, CNP Michigan Nurses Association

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1 Vaccination not just for kids anymore Karen Foren Lake, PhD, RNC, CNP Michigan Nurses Association

2 Disclosure to Participants Successful Completion of this Continuing Nursing Education Activity In order to receive full contact-hour credit for this CNE activity, you must: Carefully read the entire self study module. Complete the evaluation form and post-test and indicate responses on the answer sheet. Submission instructions and links to the post test and evaluation are on the last page of this self study. This CE is FREE for MNA members and $20 for non-members. Participants who achieve a minimum passing score of 80% will receive a certificate awarding 2.0 contact hours. Certificates will be mailed within six weeks of receipt of evaluation and post-test. Participants who do not achieve a passing score will have the option to retake the test at no additional cost. Conflict of Interest A conflict of interest occurs when an individual has an opportunity to affect educational content about health-care products or services of a commercial company with which she/he has a financial relationship. The planners and presenters of this Continuing Nursing Education activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. Non-Endorsement of Products The Michigan Nurses Association s accredited-provider/approver status refers only to continuing nursing education activities and does not imply that there is real or implied endorsement by of any product, service, or company referred to in this activity nor of any company subsidizing costs related to the activity. Michigan Nurses Association is accredited as a provider of continuing education by the American Nurses Credentialing Center s Commission on Accreditation.

3 Objectives Describe the burden of disease on adults and impact of vaccination. Discuss adult coverage levels in the US and Michigan. Verbalize the current adult immunization standards. Describe vaccine safety and efficacy.

4 Disease burden and impact of vaccination in the US Even with vaccines available, preventable diseases still exist. This is particularly alarming since 42,000 adults die each year in the US of vaccine-preventable diseases. Adult coverage of immunizations is very low, under 50%. Adult clients may now be recommended to receive up to 13 vaccinations.

5 Burden of disease in US adults Hepatitis B (Hep B) 3,350 cases reported in Human Papillomavirus (HPV) an estimated 79 million Americans are now infected. Fourteen million new infections are reported each year. Zoster (Shingles) about 1 million cases reported each year.

6 Burden of disease in US adults, continued Influenza varies from year to year. There is an average of 226,000 hospitalizations (with more than 75% being adults) each year. There are also 3,000-48,000 deaths annually (with more than 90% being adults). Invasive Pneumococcal Disease 38,750 cases reported with 4,000 deaths each year. Pertussis (Whooping Cough) 28,000 cases reported each year with 9,000 being adults.

7 Co-existing conditions can complicate matters Adults with diabetes (both Type 1 and Type 2) are at higher risk for complications from vaccine-preventable diseases. Influenza can raise blood glucose to dangerous levels. Adults with diabetes have higher than normal rates of Hepatitis B. Adults with diabetes are at increased risk for death from pneumonia, bacteremia, and meningitis.

8 Co-existing conditions can complicate matters, continued Adults with asthma or COPD are at higher risk of complications from vaccine-preventable diseases. Adults with asthma or COPD are more likely to have complications from the flu. Since asthma and COPD cause the airways to swell and become blocked with mucus, the addition of certain vaccine-preventable diseases can lead to pneumonia. Cigarette smoking also places adults at higher risk for pneumonia.

9 Vaccination coverage rates among adults for influenza and pneumonia Influenza vaccination rates have increased from 40% in 2012 to 45% in This is well below the Healthy People 2020* targeted rate of 75%. In those at risk for pneumonia, the vaccination rate has stayed at 20% for adults under age 65. For adults over age 65 at risk for pneumonia, the vaccination rate has stayed around 60% for the last 5 years. *Healthy People 2020 is the science-based, 10-year national objectives program for improving the health of all Americans.

10 Vaccination coverage rates among adults for HPV & Hep B For HPV in women aged 19-26, in 2015, the vaccination rate increased slightly to 40%. For HPV in men aged 19-26, in 2015, the vaccination rates were below 10%. For both men and women, in 2015, the Hep B vaccination rates were slightly above 60%.

11 Vaccination coverage rates for Tdap (Tetanus, diphtheria and pertussis) Pertussis, once thought eradicated, has recently occurred in infants and adults at an alarmingly high rate. In adults over age 19, in 2015, the vaccination rates were only 20%. In adults over age 19 and living with an infant, in 2015, the vaccination rate rose to 32%.

12 Tracking Michigan s immunization rates The Michigan Care Improvement Registry (MCIR) website can be utilized by local health departments, health care providers, and the public to record and check vaccinations. The waiver rates from those declining a vaccination are also listed.

13 Why we need immunization standards Most adults are not aware that they need vaccinations. Significant immunization disparities exist across socio-economic statuses. A recommendation from health care personnel is the strongest single predictor of whether patients get vaccinated.

14 Adult vaccination standards include: 1) Assess; 2) Recommend; 3) Administer or; 4) Refer; 5) Document.

15 1) Vaccination assessment Assess the immunization of all patients at every clinical encounter. Implement protocols and policies for vaccination. Ensure that patients vaccine needs are routinely reviewed. Ensure that patients get reminders about the vaccines they need.

16 1) Vaccination assessment, continued Utilize vaccine questionnaires these help identify vaccine needs and get the patient s attention regarding their immunization history. Screening for vaccines review contraindications and precautions before administering.

17 2) Vaccination recommendation Share reasons why this vaccination is right for the patient. Highlight positive experiences. Address questions and concerns. Explain the cost of getting sick.

18 The provider side of vaccine recommendation Health care providers (HCP) commonly discuss with their patients: The consequences of not being vaccinated. The safety and efficacy regarding the vaccination. The possible side effects of a vaccination. The benefits of vaccination. HCPs traditionally believe that vaccination is an adult s choice and are reluctant to be insistent unless they believe the adult could get seriously ill.

19 The patient side of vaccine recommendation Adults: Favor simple and to-the-point messages. React positively to messages that stress prevention and make them feel as though they are in control of their health. Prefer empowering messages ones that provide information that can help them make an informed decision.

20 Talking to adult patients about vaccines Common questions the patient may ask: Is this vaccine really necessary? What is my risk of contracting a disease? Are there any risks to getting this vaccine? Does this vaccine work? How do I know this vaccine is safe? The US has the safest, most effective vaccines in the world. Extensive four- phase studies are completed before the vaccine is approved in the US. This usually takes many years. The FDA approves medications only after extensive review of the vaccine and inspection of the manufacturing plants.

21 3) Administer or refer Adults may be vaccinated in a variety of settings including: Family medicine (typically have 70 visits per 100 people). OB/GYN (typically have 64 visits per 100 people). Internal Medicine (typically have 46 visits per 100 people). Local Health Department stocks all required vaccines. Of 100 people, 70 visit a Family Medical Clinic regularly, making it the most likely place to get a vaccine.

22 4) Vaccine referral Refer patients to providers in the area that offer vaccines not stocked on your unit. Be prepared to give an informed referral for vaccines not stocked. Confirm (with the patient or provider) that vaccines were received. Follow up with patient to ensure there were no side effects.

23 5) Documentation Document all administered and past vaccine doses in MCIR. Document in patient s EMR. Communicate: help your office and patient s other providers to know which vaccines your patients have received and which are due.

24 A word about mandatory vaccinations The Michigan Nurses Association (MNA) supports the use of vaccines in nurses, but does not support mandatory flu vaccination. MNA believes the right for a nurse to take or refuse a flu vaccination for themselves should be upheld. Contact MNA at or 888-MI-NURSE if you have questions about this policy.

25 References and resources Alliance for immunizations in Michigan: aimtoolkit.org The American Academy of Family Practitioners: AAFP.org Centers for Disease Control: edu.gov The Children s Hospital of Philadelphia, Vaccine Education Center: chop.edu/centers-programs/vaccine-education-center Immunization Action Coalition: immunize.org Michigan Department of Health and Human Services: Michigan.gov/immunize Thanks to Chris Zilke, RN/Vaccination Coordinator/Washtenaw HD

26 Post-test information POST-TEST DIRECTIONS This CE is FREE for MNA members and $20 for non-members. Complete the evaluation and post-test response form and make your payment online by clicking HERE. OR Download and complete the evaluation and post-test response PDF FORM and send to: By mail: Michigan Nurses Association, 2310 Jolly Oak Road, Okemos, MI By fax: AWARDING OF CE Participants who achieve a minimum passing score of 80% will receive a certificate awarding 1.0 contact hour. Certificates will be mailed within six weeks of receipt of evaluation and post-test. Participants who do not achieve a passing score will have the option to retake the test at no additional cost. Michigan Nurses Association is accredited as a provider of continuing education by the American Nurses Credentialing Center s Commission on Accreditation