Event ID: Shot From the Heart: Flu and Pneumonia Shots and the Importance of Continued Vigilance Event Started: 1/17/ PM

Transcription

1 Event ID: Shot From the Heart: Flu and Pneumonia Shots and the Importance of Continued Vigilance Event Started: 1/17/ PM Good afternoon. My name is Morgan from the New England QIN QIO and I will be your moderator for today's webinar-shot From the Heart: Flu and Pneumonia Shots and the Importance of Continued Vigilance. The QIN QIO works with healthcare providers, stakeholders and communities on data-driven quality initiatives to improve patient safety, engagement of families and improve clinical care at the community level. Thank you for joining us for today's webinar. Before we get started I wanted to go over a few housekeeping items. This call will be recorded for training purposes. I will provide you with details on accessing the recording at the end of this webinar. I have placed the phones on mute for the duration of the presentation however if you can also manually mute your lines to make sure we don't get feedback we would appreciate that. We will be taking questions at the end of the presentation and I will provide instruction on how to unmute at that time or you can pose a question in the chat box on the right-hand side of your screen throughout the presentation, we were review those at the end. At this time I'd like to introduce our presenters for today's webinar, Kathryn Roby and Russell Cooney and I will pass it over to Russ to get it started. Good afternoon and welcome to Shot From the Heart: Flu and Pneumonia Shots and the Importance of Continued Vigilance. My name is Russ Cooney and I am the task lead for immunizations for the New England QIN-QIO. The objectives for this session -we will understand immunizations cycle, a timeline of incidents of influenza and when it peaks annually. Understand the relationship between timely immunizations and decreased avoidable admissions and admissions to the hospital, be able to encourage all eligible persons to be immunized in a timely manner and how to counteract vaccine hesitancy. As you can see the peak four confirmed cases varies from year-to-year. This is the number of confirmed cases from 2014 to So for is tracking was similar to last year. Last to peak was a mid-march. Widespread flu activity is now reported over 25 states according to the CDC for a CNN report on January 3rd. This includes four out of the six New England states. Currently main is seeing regional activity and Vermont only local activity. Widespread means more than 50% of geographic regions in the state, counties for example are reporting collectivity and addresses this spread of the flu and not its severity.20 states experience a high proportion about patient visits to after providers

2 for flulike illnesses. This you the most common strains have been H1N1 and 83 and 2. Last year before hospitalized 170 when children die and what is being called a relatively severe season. The CDC estimates flu vaccination prevented 6.6 million illnesses last year, 3.2 million doctor visits and 79,000 hospitalizations. Just a reminder antiviral medications when taken early is recommended for patients with confirmed or suspected influenza who have severe complicated or progressive illness who require hospitalization or at high risk for serious influenza related complications. This increases the risk of medical complications to the most probable patients especially those with chronic illnesses anyone you can get immunized would benefit greatly. On this slide you can see the people flu seasons can vary from year-to-year. As an example last year the peak did not occur until March 12th and looks like this year is very similar to last year in the pattern we are starting to take. The CDC both the publishing the vaccine effectiveness data in mid-january which should give a good indication of the effectiveness of this year's match. Factors influencing getting a flu shot include cold weather, convenience, transportation and includes myths and misinformation in the media sensationalizing when there are issues. Of course always the confusion about the different immunizations. When to get creative on how we approach our patients. Anything we can do to mitigate factors will help. On average only two out of five have gotten their flu shot this year so if you look around the room you and imagine only two of the piping immunized and there is still a substantial risk so the more we can get people vaccinated, the better. Kathy will talk more about this in a few minutes. How do you counteract hesitancy? One of the single most important factors is a strong provider recommendation. Also using promotional materials that expelled on the benefits of immunization such as protecting Elders and those with chronic conditions and you want to be willing to share your own reasons for getting a flu shot and how it is handled within your practice. That personal connection can sometimes they call the difference by being open and honest with patients about questions and concerns, we can keep open channels of communication and decrease the likelihood they will get immunized. Leaving things out or cherry picking answers will only increase hesitancy. I now pass the ball to Kathy to speak more of the data and the plan going forward. Thank you, Russ. If October has always been the flu shot primetime season, the question we want to ask is why are we talking about this now? Russ has shown us in the previous slides the peak of the flu season last year was March 12th.That is literally

3 eight weeks away. The CDC is predicting the flu primetime or peak of the season is actually going to be March 14th.A two date difference. In the next eight weeks, we need to do everything we can in order to ensure the least number of people possible get the flu. When you look at Russ's slides from earlier, what you are saying is the peak for positive confirmed cases. If you look at these scholars as they advance on your screen, what you're going to see clearly documented is the peak of the flu season is January, February and now March with March seeming to be two years in a row the very peak of the season. Russ has talked a little bit about the relationship between immunization and acute-care hospitalization. Here at the QIN QIO would tend to look at everything in the context of what the data tells us. For those of you in physician practice, for those of us out in the home health and hospice communities, we are tracking hospitalization and are emergent care episodes and we're clearly seeing there is a data-driven relationship between the percentage of our patients who are properly and timely immunized for influenza and pneumonia and the reduction in the number of emergent care and acutecare we admissions. We believe we can demonstrate to you this clearly is a relationship. In preparation for today, I went to the data and I took a very close look at the hospitalization rates in the six New England states. I compared those to the riskadjusted rates for the country as a whole. Each of the states is listed here and for the sake of our pride, I have not identified the numbers that go with each state. Let's take a quick look at how these numbers shift month by month within each state. State number one at the top. This is there hospitalization rate compared to the national rate. It is literally double in January and although it does decrease slightly in February, March and April is still nearly double the national rate. Why? Russ has already told you there is a focus of increased confirmed cases of influenza in the Northeast region so here it is, the flu is here, no money is here, acute-care hospitalizations are rising. As you look at each of the states you will see states 5 and 6 have the lowest number. They are closest to achieving the national risk-adjusted rate of immunization. Hold that thought as we move to the next slide and consider the immunization rates for those same six states. Nationally the immunization rate for influenza a 72.7, nearly 7 3%. For pneumonia it is 75%. In other words, three out of every four people in the room eligible had a pneumonia vaccine. You're the same three out of four had an influenza vaccine. Let's look at states 5 and 6. Lookout close they are. They in fact exceed those national averages by a significant amount and they had significantly lower hospitalization rates. Take a look at state number one. The highest hospitalization rate and the lowest immunization rate. 69%.Only two out of the as opposed to 3 out of 4 received the vaccine in this particular state. Clearly there is a

4 data-driven relationship. Let's ask ourselves why. What is causing these patients who are not immunized to be admitted to the hospital? The three most frequent causes for unplanned hospitalizations are respiratory infection, respiratory distress and congestive heart failure. Clearly these are directly related to influenza and pneumonia. There is a direct demonstrated relationship between higher immunization rates and lower hospitalization rates. There was a clear drop in hospitalizations following the October immunization campaign. If you look six weeks out from the peak of immunization clinics which tends to be from the 25th of September 2 the 15th of October, that is when you see signs for flu clinics everywhere. There are lines at CVS and Walmart and Rite Aid. There are lines at the senior center when the nurses show up to give flu shots. You don't get as much resistance in your office when you're asking your patience when they come in to get a flu shot and hospitalizations six weeks later. In quarter one, January February and March, those 3 out of 5 people who chose not to be immunized are getting sicker and the acute-care hospitalizations are rising and the causes, documented data-driven causes. What do we do about this? I have always been a person who if you present me with a problem I want to act. I don't want to sit around and have a lengthy conversation. What could be due? We know all the advertising, all the conversations in the pushing and the papers and posters and everything we have done has made the October flu shot primetime season very effective. I think it's time for a second season. We need to create and develop an impetus behind immunization initiative, a second season. We need to tell people it is not only too late, it is primetime again. What can we do to develop an action plan? The first step is to identify the people at risk who have not been immunized. In your setting, in your part of the healthcare continuum, how would you go about doing that? If you are a physician practice with an electronic medical records system, if you're not sure how to do it, get in touch with your vendor and don't let them get away and to he tells you how to run the reports that can tell you who won your case load has not been immunized for flu and pneumonia and is eligible to receive that vaccine. Then we need to think about how we're going to overcome that hesitancy Russ spoke about. What are we going to say and do that is going to reach them, going to convince them and get them in there two office to be immunized in a quick and easy fashion. Any kind of an initiative has got to have some kind of the theme, some kind of a motif that is going to be quick and catchy and get people is attention. We can almost literally distract them from that and take the first step to overcoming that hesitancy. Something simple, don't get the flu, get the flu shot. Whatever you choose or how you choose to phrase it you need to create that been. Thing you need to carry your outreach and education materials around that. The CDC, the American lung Association, the World Health Organization and a multitude of

5 others all have tremendous free education and outreach materials you can access and we've into your theme and your process. Speaking of process, once you get these people's attention, once you get them nervous enough to be motivated to not be hesitant and uncertain and want to get their flu shots and be part of the second season, how are you going to schedule and immunized them in a way that is going to be quick and easy and not discourage them from coming in? If they agree to do it and call your office and can't get an appointment until the first of March, we haven't accomplished anything. If they call your home care agency and say where can I get a flu shot and you say we don't do that, that is not quick and easy and that's not helping. Think about what kind of a process you going to use, habit in place before you send out your education and outreach materials. Before you start making phone calls to everyone in your case load that did not get a flu shot. How will you do this? Recently I had a reason to stop into my family practice office. They have had posted over one half of their check in window, a sign that says EZPass flu laying for people who had an appointment to get their flu shot. All they needed to do was to walk in and show their insurance card and give their name and they received their influenza consent form, fill that out and by the time they had gotten to their signature, they were already being called. I watched people get their flu shot and get out again in 10 minutes. Can you do that in your office? Can you create a system and a process for an EZPass flu laying for your patience? What about for those of us who serve other people out in the community whose patients don't come to West, we go out to them? You need to think carefully about how you want to do that. Can you get standing orders? Can you get a kit so you can send your nurses out into the community to work on getting people immunized that of culture agency and asked for assistance? Can you run a flu clinic this winter? Consider how you would do this, how to create the process, how to get the visits scheduled and how to get this done. For those in the home health community I have done a great deal of work on a one-to-one basis. If you're interested in attacking this problem, after this program is over reach out to me at the contact information at the end and I will be happy to work with you on a one-to-one basis. Went to have created your team and your process, educate and motivate your staff. It is not going to be very successful if your own staff did not get immunized and are saying under their breath maybe you, but not me. What was your decision as a healthcare provider? Did you require your staff to get the flu shot, to get a pneumonia vaccine if they were eligible? You should first consider this because you don't want to be sending out a mixed message. You don't want to be telling your patience and clients you need to be immunized but not me so make a plan, make a decision and educate and motivate your own staff, develop the theme and the materials, create the process and reach out to the patients you are responsible f or. You want to have as a goal that you will have

6 conducted your outreach, your education and immunized as many as possible between today and the next four to six weeks. Your target should be between the 20th and the 28th of February to complete this project. Always include in your handouts and education handouts and flyers on effective handwashing and practicing infection control. If you go to the World Health Organization website, in their search box you type in cleaning hands saves lives, it will take you to a website where you can order free and eight at half by 11 sheet with instructions for the seven steps for handwashing and hand rub and post them in every bathroom on every door in your office. Hand them out to every person you come in contact with and continue to gather the data on how your practice and your agency is doing on immunizing your patience in looking at what percentage are still going to the emergency room or the hospital because you want to investigate every one of those and be sure you have done everything you can possibly do to prevent that emergency room trip or hospitalization. As Kathy was talking, standing orders is an important practice. This slide shows the interventions to increase adult immunization. At the top is organizational change which includes standing orders and having separate clinics. If you don't have standing orders you may want to consider it. We re going to provide resources at the end to help this process but some of the simple things, 10 steps to implementing standing orders. Administering vaccines and standing orders for pneumococcal vaccines as well as influenza. If you were able to do these things I'm sure your immunization rate will go up and is Kathy said that example of the easy pass is wonderful. I recently went to a specialty office and unfortunately they do not immunize their staff and they don't have a process and that sets the patients up to become infected through the provider. Anything you can do to promote immunizations in your practice and for people to have the convenience and ability to go in and out quickly would certainly help. Kathy, you have some helpful hints to share? I do. I am one of those people who think you can get a short and simple and catchy theme you're going to attract people's attention. How many times have you heard a buzz word, a phrase in a commercial and hours later it is still in the back of your head? Look for a catchy theme. It is almost February, heart health month. Heart health starts with you. Get your flu shot today. Order buttons. People still well wear them, but this for your staff that say I got the flu shot instead of the flu. Look for those flyers, the American lung Association, the CDC, they all have them and you can customize that flyer that says flu facts and why you should get your flu shot today. Make the process as easy as it possibly can. Physicians offices, nursing homes, hospitals, home health providers, we all should first make sure our staff is fully informed, fully supported and as many as possible have gotten their flu shots. The next step is we need to work together. We need to communicate better to one another. If a patient who is traveling across our continuum has gotten a flu shot in the hospital,

7 during the rehab stay in a skilled facility, we need to know that when they come back to the physician's office where they are seen by their home care provider, we need to know they had the flu shot and when they had it and there was no reaction. We cannot rely on our patients as much as we would like to remember to tell us these things. Those of us in the community without bricks and mortar, physician practice, home healthcare providers, community service agencies, we all need to work together. We need to be sure it is well documented in our records whether it is a sticker that is brightly colored, some were noted on a sheet that this person has or has not had a flu shot or a Pneumovax nation. What about the few people who are not eligible. You need to make sure those files are marked so we are not continually asking them but instead those people should be focusing on proper handwashing, infection prevention, avoiding crowded places so they are not getting exposed to some things they are not able to be immunized against but we need to work together and communicate better. We need to help each other to get standing orders, to get responses back and make sure the system works as quickly and effectively as we can for the welfare of our patients. If we coordinate together between physician practices and community-based providers, we can identify all of the at-risk patients, we can establish reportable assessment parameters and emergent care borders that will enable the communitybased providers to manage care in-home to reduce acute-care hospitalization so when a patient is first picked up as a home health patient, if physicians and community health providers are communicating effectively, there will be a simple clear communication. This patient has CHF, if they get in the exposure to the flu, if they become symptomatic. If you have emergent reportable assessment parameters and emergent care orders, you can keep that person safely at home most of the time. Make sure you have simple easy to read, easy to follow handouts. I can't tell you how effective those tools are that you can get on the World Health Organization website. I get so excited when I go out to visit providers, I go into the ladies room and out every door and there is the hand wash hand rub poster. When I walk into a conference room or an office and I see the pure row on the desk, I see the sign on the back of the door, this is what we need to do. When to find simple informational handouts with pictures, cartoons or whatever. Something to remind people to sneeze into their sleeve, use a tissue to open bathroom door is, anything simple like that and simple first aid steps, how to recognize what symptoms they need to treat, what symptoms they need to notify the physician for. We also need to look at a call the nurse first methodology, whether it is in your physician office practice or your home care agency. We want patients to think and follow the simple steps. If you have these symptoms call the nurse first. Designate someone in your practice who is going to be the first line, the advice nurse in your practice office so when those calls come in, someone is available to take them quickly and give them practical advice, squeeze them into the office to be

8 seen before they panic and go to the emergency room unnecessarily. If we educate them they will follow through. They will call us and follow our instructions and hopefully stay well enough not to have to go to the emergency room. Why should we do this? Informational quality reporting is becoming more publicly available and with recent changes and pay for performance building you want to position yourself to be the go to provider for patient centered medical homes and neighborhoods. As you all know people do look at five-star ratings. You want to make sure you keep your rating where it belongs and make sure hospitals and ACO's and practices see you are the one they want to turn to like getting into these partnerships, it can only benefit your agency. There also the increased risks and increased ED use. Medical complication patients. Increased hospitalizations and an unfavorable public perception. The last thing you want to be is the one agency that doesn't have what is necessary to provide the care for the patients when a providers looking for it. Why should we do this? All the reasons on this slide but also because it is the right thing for the patient. You want to make sure you do what is right for the patient. In February and March a lot of people get hospitalized with an ammonia and flu at all complications were chronic illnesses. We can save lives by doing these simple steps so I believe it is worthwhile to do. If we work together we can make this second season initiative as successful as October and the peak of immunization and influenza. It is really important we get everything out there and able to share our experiences and make it easier for everybody including the patient and the providers. Kathy, anything you would like to add? I think that's it. I can't stress enough how important it is. We do not have a shortage of vaccine. If you have any questions at all about how to get it or where to get it, you can contact us or your local department of public health and they should be able to guide you. For those in the home health community, your medical director can assist you if you need a script to obtain that vaccine. If you need assistance with writing policies or procedures, please contact us. It is not that scary if you have not done it before. It is not difficult to do and it can be a very effective process. If we work together we can make this very successful. We just need to remember M arch 14th is not that far away and we want this the spring peak this year to be the lowest it has ever been. Would like to see it not show up as anything more than a bump. If you need anything from us please give us a call. Thank you. Morgan, can you let participants how to ask a question? Sure. If you do have a question you can put it in the chat box or press # 6 to unmute your lines. While we wait for folks to decide if they have a question, we did have one question come in the chat. Do we have published data on what percent of immunized

9 patients get hospitalized because of a failed immunization? Also immunization rates for flu and pneumonia have more than doubled in the past seven years, I would like to see data on reduction in hospitalization rates. In-home health, we know the hospitalization rates have progressively come down over the last seven years. I have been with the QIN QIO for 10 years and the hospitalization rates in general have progressively gone down in the 10 years I have been looking at them. I don't have any specific information today about hospitalizations related to immunization failure. Russ, do you have anything? Unfortunately a lot of the states use Sentinel data when figuring out their rates and that is only a small portion of the total population so it's difficult to get any type of data. I think the best thing we can do is look at the number of people who have been hospitalized, the number of infections and look at what the overall impact is. At some point we will get to where we are able to measure all that data but at this point I don't think that is possible. That was our only question at this point. Again if you want to ask a question on the line press # 6 on your phone. It doesn't look like any questions or coming in. It looks like there's a few more slides, I didn't know if you want to advance those before I close out. It looks like there is one more question. Is there a plan for Rhode Island Department of Health to make PCV 13 available to long-term facilities? Any mandates for longterm health care facilities to offer PCV 13. At this point I can't speak for the Rhode Island Department of Health but I know they are looking at the cost-effectiveness of the PCV 13 because it is quite pricey and I know that is part of the conversation for next season but I'm not sure if it is happening this season. I know the last time I looked at was not available. This next slide has a lot of resources out there. You get to the CDC or the immunization action coalition on different handouts you can give to patients. Some of them are unbranded. I know people can be hesitant about taking information from scientific journals and the World Health Organization. If you get unbranded material people feel more secure with the information, I think that helps when it comes to hesitancy. As I said earlier there is a lot of information on standing orders and if you have any questions or looking for any data or information, feel free to give Kathy or me a call and we will make sure we can get back to you right away. Anyone have any other questions?

10 I have pointed people to the QIN QIO website. In October we did do a webinar with specific instructions for home health providers on how to go about setting up an immunization program complete with processing and other specific details so if they go to the website you will find that under previous webinars. Thank you. Any questions again, # 6 to unmute your line. It looks like another one came into the chat. As the new infection control officer I have committed to improving our faxing compliance rates with staff in our clinic. Any comments on nonimmunized staff who should be wearing masks and when and how to address noncompliance with mask wearing? Also may we up tame copies of the size. I will put that into the chat again but I didn't know if you had any thoughts on nonimmunized staff. At least in Rhode Island if we are in widespread mode, any staff and immunized have to wear masks. You need to take a hard line when it comes to stamp with the masks because if you don't it makes the law ineffective. I think when you wanted to an office in you see someone without a mask you need to say something because people will then realize the patients are concerned about it and it has to be a bigger issue. Hopefully the physicians are leading the way and giving a good example to people on the importance of having immunizations and make it a huge public thing where they take a picture and post in waiting areas and they encourage staff to get immunizations. It is not an easy thing and there are always going to be people who have an exception or don't want to get the flu shot at if they make that choice they need to be masked and it's your job to make sure that happens. Is the only way we can protect patients and staff. We know how difficult it is when someone gets sick because pretty soon everyone is sick and is a lot more absenteeism and we all have enough already without having that happen. Exactly, I agree. I visit a lot of different providers and in the last two weeks I have been in agencies in Connecticut and Massachusetts and then both of those agencies, I watched on Friday the supervisors with staff coming and going in and out of the agencies, the supervisors were handing out baggies of masks to those few people who have for whatever reason not been able to get a flu shot or made the decision notto be immunized and they were reminding them that spot unannounced home visits would be made and if you made that choice, you needed to wear your mask and they gave him advice about how to address it so they were not embarrassed in front of the patient but also sticking to the agency's commitment to get everyone immunized. It was suggesting to staff that you made the choice and that is your choice however we have an obligation to protect patients. One of the things they can do is offer staff a line or statement they can use when interacting with patients. My children have a cold at home and I don't want to pass it on to you. Whenever they might offer them but

11 something that presents it as tolerance and not intolerance but still making the point this practice the agency is committed to 100% immunization. As a side that Kathy- I was in the specialty office last week and asked the woman at the desk do you get flu shots and are they mandatory and they said no and she said she didn't get one yet sitting on the counter was a statement saying a patient coming in with flu symptoms has to wear a mask. I found that a little ironic. To say the least. And they clearly haven't considered the impact as an employer running a home care agency with over 300 staff. We look at the cost of sick time in the winter months from October 1st through April 1st in determined comparing two years side-by-side, the year we began mandating immunizations that sick time and the cost of having to replace those staff in the field, the cost of lost reimbursement for services provided was so large that we saved three times the amount of money we spent on the flu shots and we paid for the shots for all of our employees so considered impact it will have on your own costs if you do have a program like this. Thank you for that great discussion. Russ if you could go to the last slide, we did have a few announcements before we end today's call. As you can see we are now on social media so please connect with us on Facebook and/or LinkedIn for the greatest resources and webinars and other offerings from the New England QIN QIO. As you close out the evaluation will pop up on your computer. If you could fill it out we would appreciate it. If you don't have time right now or you are currently sharing a computer you will receive an with the link to the a link to the evaluation as well as a link to the events page on our website. On that event page you will find a PowerPoint presentation for today and in the next few business days we will also be adding the recording and be recording and transcript from today's webinar. Thank you all again for joining. Thank you Russ and Kathy and have a wonderful day. [Event Concluded]