To report status of 4 intervention strategies at 23 SCI centers one year following completion of an implementation project to increase rates of respiratory vaccines by veterans with a spinal cord injury or disorder (SCI/D).
Observational study; 30 months of data collection.Facilitation used to implement intervention strategies.Facilitation: Helping individuals and teams understand what they need to change and how they need to change it to apply evidence to practice. Framework: purpose, activities and roles; continuum from specific help and support to enabling teams to change ways of working (Quality and Safety in Health Care, 2002).Qualitative data collected about the status of each intervention: e-mail questionnaires, semi-structured interviews.
Patient reminder letters and educational materials. Staff at one SCI Center telephoned patients; staff at 14 SCI centers reported sending letters and educational materials to patients; staff at 3 SCI centers reported their VA medical centers sent letters to patients.Computerized clinical reminder (CCR) for influenza. Staff at 14 SCI centers used this CCR to document influenza vaccinations. Staff at 8 SCI centers used another location in electronic medical record to document influenza vaccinations; staff at one SCI Center had begun using this CCR.Standing orders policy. A variety of mechanisms can authorize nurses to give influenza and pneumococcal vaccines without an order. At 22 SCI centers, nurses were authorized to give influenza vaccine to outpatients without an order. At 17 SCI centers, nurses were authorized to give pneumoccocal vaccine to outpatients without an order.Information about influenza and pneumococcal vaccines to practitioners. An indirect measure, staff influenza vaccinations, showed higher staff vaccination rates at 15 SCI centers one year after project than first year of project.
Intervention strategies were modified in SCI centers after project staff completed facilitation activities.Factors affecting implementation of intervention strategies: complexity of the strategy, structure of medical centers and SCI centers, policies about staff responsibilities and organization of patient care.