Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
J Am Med Dir Assoc. 2010 Sep;11(7):523-7. doi: 10.1016/j.jamda.2010.04.001.
A performance improvement project was undertaken to increase health care worker (HCW) influenza vaccination acceptance rates in the long-term care setting by using a novel 15-minute education intervention called the "Flu in 15." As a core principle, we taught that more Americans die from complications of influenza than hepatitis B, yet there remains individual reluctance and barriers to achieve high acceptance rates of influenza vaccination among HCWs.
During chance encounters we offered the Flu in 15 in-service to all HCWs at the Johns Hopkins Bayview Care Center including certified nursing assistants (also called geriatric nursing assistants), registered nurses, registered dieticians, environment staff, physical therapists, occupational therapists, speech therapists, respiratory therapists, social workers, and administrators. Of the 106 of 347 HCWs who participated in the Flu in 15 in-service, 58 were by chance encounters selected to be surveyed based on convenience. We surveyed 68 of 241 HCWs who did not attend the Flu in 15 in-service as a comparison.
Of the 58 participants who were asked if the in-service helped them understand why a flu vaccine is needed yearly, we found that 15% responded "tremendously," 48% "a lot," 26% "some," 7% "a little," and 2% "no." We had 24% report that the program was effective in changing their behavior to accept the flu vaccination for the first time. We found that 49% responded that the in-service was effective in either changing their behavior to accept the flu vaccination for the first time or reaccept it if recently declined in previous years. With respect to motivation, 42% of the certified nursing assistants stated that the in-service made them think more about returning to school to get a license in some area of health care. Although not cause and effect, we observed an increase in the HCW acceptance rate of the influenza vaccine from 65% in 2006-2007 to 73% in 2007-2008. We noticed a decreased trend in patient deaths attributed to complications of influenza with 4 deaths in 2006-2007 and no deaths in 2007-2008.
The Flu in 15 in-service promoted a better understanding of the importance of the influenza vaccine and demonstrated an associated increase in HCW acceptance of the flu vaccine. Although we cannot claim cause and effect, we noted a decrease in resident mortality in the intervention year compared with the prior year. Now that some medical centers require yearly influenza vaccines among HCWs, the education component remains relevant to provide reason behind the mandate.
为了提高长期护理环境中医疗保健工作者(HCW)的流感疫苗接种率,我们开展了一项绩效改进项目,使用了一种名为“Flu in 15”的新型 15 分钟教育干预措施。作为一个核心原则,我们教导说,死于流感并发症的美国人比死于乙型肝炎的人还多,但 HCW 对流感疫苗的接受率仍然存在个人抵触和障碍。
在偶然相遇时,我们向约翰霍普金斯湾景护理中心的所有 HCW 提供 Flu in 15 在职培训,包括注册护士助理(也称为老年护理助理)、注册护士、注册营养师、环境工作人员、物理治疗师、职业治疗师、言语治疗师、呼吸治疗师、社会工作者和管理人员。在参加 Flu in 15 在职培训的 347 名 HCW 中的 106 名中,根据方便性选择了 58 名偶然相遇的人进行调查。我们对未参加 Flu in 15 在职培训的 241 名 HCW 中的 68 名进行了比较调查。
在被问到在职培训是否帮助他们了解为什么每年都需要接种流感疫苗的 58 名参与者中,我们发现 15%的人回答“非常”,48%的人回答“很多”,26%的人回答“有些”,7%的人回答“一点”,2%的人回答“没有”。我们有 24%的人报告说,该计划有效地改变了他们的行为,第一次接受流感疫苗接种。我们发现,49%的人表示,该计划有效地改变了他们的行为,要么第一次接受流感疫苗接种,要么在近几年拒绝接种后重新接受。关于动机,42%的注册护士助理表示,在职培训让他们更愿意考虑回到学校,获得医疗保健领域的某个许可证。虽然不是因果关系,但我们观察到 HCW 对流感疫苗的接受率从 2006-2007 年的 65%上升到 2007-2008 年的 73%。我们注意到,由于流感并发症导致的患者死亡人数呈下降趋势,2006-2007 年有 4 人死亡,2007-2008 年无人死亡。
Flu in 15 在职培训促进了对流感疫苗重要性的更好理解,并表明 HCW 对接种流感疫苗的接受率有所提高。尽管我们不能声称存在因果关系,但我们注意到干预年度居民死亡率与前一年相比有所下降。现在一些医疗中心要求 HCW 每年接种流感疫苗,因此提供授权背后的原因仍然是教育内容的重点。