Navajo Area IHS strategies for improving Flu Vaccination

1. Navajo Area IHS strategies for improving Flu Vaccination Diana Hu, MD Maternal Child Health Consultant /Immunization Coordinator

2. Navajo Area IHS • Navajo Nation- • Covers a land mass 64,000 sq acres • Area the size of the state of W. Virginia • Population served – 180,000 + ( as of 2010 ) • 8 service units • 6 hospital based SU • 2 health center based SU • 7 health centers, 15 health stations • Approx 20% of the IHS population served by Navajo Area

3. Population differences • 50% unemployment • Significant poverty- 50% of population or more on AZ Medicaid/NM Medicaid • Largest reservation based tribe in the US • Many of our constituents do not have other care options on reservation or off reservation • Services available through IHS/Tribal SU • Larger infrastructure of clinical staff, support staff, public health nursing staff, community health staff

4. Navajo Area stats for Flu vaccination- March 2011

5. Elderly Flu vaccination

6. High risk adult Flu Vaccination

7. Infant/Toddler Flu Vaccination

8. HCP immunization

9. HCP immunization %ages

10. Best practices-hospital/clinic based- 75% of our shots • Elderly immunization/high risk adults • Start early in the season • Many patients on Q3mo cycle for routine health care • Don’t make them come in “off cycle” • Adult vaccination clinic • Pharmacists provide “on demand” immunization • Access to the RPMS imm forecast • Ask patients about vaccination when they come in for monthly refills • Fast Track walk in Flu shots • Streamline Pt Reg • PHNs /CHRs– letting patients know about the different ways they can get immunizations

11. Best Practices- hospital/clinic based • Infant/Toddler immunization • Standing orders in clinic • Consult RPMS forecast on all patients • No missed opportunities • Immunize families of infants not eligible for immunization ( < 6mo old) • Inpatients • Standing orders to offer flu shot prior to discharge for all inpatients • Post partum immunization standing orders • All post partum women rec: to get flu vaccination if not done during pregnancy • Same orders cover Tdap • Immunization of families and fathers on the unit or referred to flu vaccination clinic

12. Best practices- clinic based • Separate flu immunization clinics • Good for walk ins • Good for families of appt patients • Increases reimbursement • Staffing needs- billable provider ( provider or pharmacist) and nursing • Reimbursement more than pays for contract nurses/ NP to staff clinics

13. Best practices- community based- 25% of our shots • Community clinics • Chapter houses • Senior centers • Local grocery store on pay days • Flea Market • SCHOOLS- Head Start to High School • Contact every school at the beginning of Sept. • Consents sent home with VIS • Information on LAIV and TIV options • Coordination with school nurses • Mass Vaccination planning • Use of flu vaccination as a test run for public health emergency preparedness

14. Best practices- school based imm “blitz”- • Locate a “champion” at each school • School nurse • School wellness coordinator • Administration • Consent forms, VIS forms, quick registration update forms furnished by the hospital • Saves the costs of Xeroxing for schools • Forms sent home with kids through homeroom classes • Collected and collated by school nurses from teachers • No consent, no immunization • Order your incentives 3 weeks before the clinic • Stickers, pencils, fake tattoos, little toys

15. Best practices- school based imm- • Week before the clinic- collect the forms, make spread sheets for the classes • Clerical staff verifies that students did not already receive shots in clinic • Day of the clinic- set up stations 1 hour before clinic starts • POD director sets up the flow- • Called in by class • Do the youngest first since they are the screamers! • Registration/check in • Screening by provider • Nursing gives immunizations and incentives • Assistants help with drawing up vaccine, pharmacy helps with inventory • Data entry puts information into RPMS • Forms back to billing and coding same day

16. Local Networking – the team • Community health coordination • PHNs • Nursing staff • Commissioned Officers encouraged to be POD directors • Provider Staff • Pt Reg staff • Billing/coding staff • Data entry personnel- vaccines into RPMS • Pharmacy • IT- using Wi-Fi to hook up lap tops with RPMS access • Planning starts in June of each year

17. Best Practices- Health Care providers- TCRHCC • Mandatory Flu imm policy for all employees • No flu shot- wear a mask all season • Employee flu clinics on all shifts • 2 AM sessions for day shift, 1 PM session for night shift • Immunization by “ring strategy” on different units • Data base in employee health with coordination with HR • Don’t forget contractors, locum tenens, students and residents • Incentives for immunization • Movie tickets, raffles

18. Best Practices- Provider education • Recommendations from health care providers are very influential in helping patients decide whether to get themselves or their children immunized • Make sure all your provider and nursing staff have the up to date information on the seasonal vaccine, the risks and benefits of vaccination, the pros and cons of LAIV vs. TIV, the true side effects and contraindications for vaccination, etc. • Don’t let ignorance perpetuate irrational fears over vaccination • Make sure staff know we expect them to use evidence based medicine in their practice

19. Advertising • Message starts in Sept. • PSA on radio • Print newspaper • Local signs around town • Messages home from school • Messages all over the clinics • Every clinic visit • Would you like your flu shot today? • Document refusals

20. The message • Everyone needs a flu shot to protect not only themselves, but their family and their community • You get the flu from others in your life- family, friends, fellow students or co workers. • Don’t let yourself or your loved ones get ill because you didn’t get a flu shot • They’re not perfect, but they’re the best protection we have now!

21. Special thanks • To IHS HQW: Amy Groom, Ros Singleton, and Mike Remillard for taking on the annual task of updating the RPMS for new flu guidelines • And for keeping us all up to date on supply issues, new releases, best practices • To all the PHNs who really put out a huge effort in the community and in the schools every flu season in addition to their regular workload • To the pharmacists who stepped up to get certified to give shots and gave us another venue for immunizations • To our clinic nurses who immunize everything that breathes (or so it seems) • To our patients who trust us and accept our advice about immunizations and public health!