1104 — Healthcare Worker Influenza Declination Form Program

LaVela SL, SCI QUERI; Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University Chicago; Hill JN, SCI QUERI; Center of Innovation for Complex Chronic Healthcare (CINCCH); Smith BM, SCI QUERI; Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University Chicago; Evans CT, SCI QUERI; Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University Chicago; Goldstein B, SCI QUERI; VA Spinal Cord Injury and Disorders Services, Puget Sound Health Care System; University of Washington, Seattle; Martinello R, VA Office of Public Health; Yale School of Medicine;

Objectives:
VA SCI health care worker (HCW) vaccination rates have been low for many years (~50%). Our goal was to implement an influenza declination form program (DFP), to assess feasibility, participation, HCW vaccination, and costs.

Methods:
Prospective interventional pilot study using mixed methods to evaluate DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre/post surveys) and program costs; data were evaluated using descriptive and bivariate analyses.

Results:
The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- vs. pre-implementation (77.4% vs. 53.5%, p = 0.01). At site 1, using a "mobile flu cart," to implement the DFP, 100% of declination forms were completed in 42.5 staff hours over < 2 months. At site 2, using at a vaccination table on "all staff" meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093/site.

Implications:
DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates. Close working relationships between and among the key stakeholders (leaders, implementation teams, and research) was helpful to move an evidence-based strategy into practice. We learned a great deal about the process of DFP implementation and strategies that were successful in facilitating the DFP and gaining buy-in. Leadership support during the early stages was particularly helpful in the conceptualization and pre-implementation work required for program start-up. Facilitation workgroups at each site were necessary to tailor local plans for moving the DFP implementation forward. Local leadership championing and support was an essential factor to full HCW participation in the DFP.

Impacts:
This initiative was successful, in part, because those involved in implementation held a common goal, that of improving HCW influenza vaccination rates, ultimately to benefit Veteran and HCW health. Implementation of HCW DFP in the VA setting is feasible and may have positive clinical implications for influenza infection control/prevention.