Help your patients to beat the flu
What you and the government are doing
Although the total supply of flu vaccine for this year is expected to exceed that of last year, some delays in arrival are anticipated, which might have a substantial effect on your patients and in determining who does and doesn’t get vaccinated early.
Predictions place the amount of available vaccine at 79.1 million doses, which is more than were available in 2000.
By the end of October, 47.8 million doses will be available for delivery, approximately 26 million fewer doses of influenza vaccine than were available by the end of October 1999, with the balance expected to be available over the course of November and December.
Because of the 2001/02 influenza season vaccine delay and the large number of doses projected for distribution in November and December, the Advisory Committee on Immunization Practices (ACIP) has developed supplemental recommendations to prioritize and phase use of the vaccine for the 2001/02 influenza season. (For more tips, see guidelines and recommendations, in this issue.)
Higher-risk groups come first
Such a plan, it is hoped, will ensure that people at greatest risk receive the vaccine early and will increase the overall protection of those at greatest risk for severe influenza and its complications.
According to the Centers for Disease Control and Prevention (CDC), those deemed as high risk are the following:
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those age 65 or older;
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nursing home and other chronic care facility residents;
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adults and children with chronic disorders of the pulmonary and cardiovascular systems, including asthma;
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adults and children who required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies or immunosuppression, including that caused by medications or human immunodeficiency virus;
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children and teen-agers (6 months to 18 years) who receive long-term aspirin therapy;
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women who will be in the second or third trimester of pregnancy during the influenza season.
In light of this, how will your home health agency handle this year’s flu season?
Batten down the hatches
"Our private-duty division, Henry Ford Extended Care, is involved with influenza vaccinations in a big way," says Greg Solecki, vice president of Henry Ford Home Health Care in Detroit.
"It has contracts with our system’s HMO as well as corporations in the community to vaccinate employees at their work sites. Concurrently, Henry Ford Health System offers the vaccine to all home health care and extended care staff as well," he explains.
Despite the close coordination with other community groups and HMOs, Solecki says the "past few years have been challenging in terms of obtaining serum in time for the flu season. Accordingly, we have a system workgroup that meets prior to the anticipated flu season. It has done a good job of building consensus regarding the distribution of the vaccine when it finally arrives," he adds.
"Patient and employee groups are assigned priorities [e.g., immunosuppressed patients first, staff who provide care to immunosuppressed patients next, etc.]. Staff who have no patient contact are assigned the lowest priority but eventually are offered the opportunity for vaccination when the supply permits," Solecki says.
St. Cloud (MN) Hospital Home Care and Hospice also participates in communitywide planning when developing its vaccine program, says Kathy Kieke RN, MSN, care center director.
"Last year, the county called a meeting including major health care providers, parish nurses, etc.," she explains, noting that the same approach will be used again this year. "They work with the media to publish the community plan, and everyone is asked to participate."
Occupational health and the infection control nurse represents St. Cloud, she says.
The results of the meeting determine who will get the vaccine on a priority basis. "Generally, home care patients, the elderly, and pediatric patients are in the top-priority groups," Kieke says, adding that nursing home residents usually are included in this group as well. "After this group is vaccinated, then come health care workers, and then the general population."
While many agencies are gearing up for the flu vaccination season, some agencies have found that their service area is already well-covered. Kim Stout, RN, BSN, home health director at McAlester (OK) Regional Health Center Home Health, says her agency has stopped providing flu vaccines, unless specifically ordered by a physician for one of the homebound patients.
"This decision was made after a project we did two years ago . . . with the state of Oklahoma in an effort to get everyone vaccinated. After all was said and done, we found that approximately 90% of our active patients had already received their influenza vaccine at their physician’s office or during a hospital stay," she says.
"The county health department also holds free influenza clinics at all of the communities and local senior citizens centers, in addition to making home visits upon request to administer vaccine. We ended up wasting several vials of vaccine and decided that we would no longer provide this type service," she adds.
"We felt like our service area had appropriate access to the vaccine. In the event that a patient does not have access, we go to the physician’s office and obtain the dose and administer it to the patient. This worked out very well for us last season and have plans of doing the same this season," Stout points out.
If your agency does plan to distribute flu vaccines, but is concerned that area shortages may prove problematic, take heart. "One interesting phenomenon we observed last year was those who received vaccinations earlier than others [such as October or November] were more susceptible to acquiring the flu later in the season [such as February or March], Solecki says. During the prolonged wait for the serum, there were no reported outbreaks of influenza, so in essence, the late shipment of serum did not appear to adversely impact anyone — contrary to everyone’s concern — and may have actually positively impacted folks toward the end of the flu season."
[Those home care providers and hospitals that find themselves with excess vaccine or extreme shortages are urged to call or e-mail their state health contact person. CDC officials note that while the total supply of influenza vaccine is already booked, it’s expected that some overbooking occurred, in which case your agency might be able to access supplies available later in the season. For a listing of state health contacts, see: www.cdc.gov/nip/flu/state-contacts.htm.
For more information, contact:
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Kathy Kieke, RN, MSN, Care Center Director, St. Cloud Hospital Home Care and Hospice, 48 29th Ave. N., Suite 15, St. Cloud, MN 56303. Telephone: (320) 240-3265.
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Gregory Solecki, Vice President, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500.
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Kim Stout, RN, BSN, Home Health Director, McAlester Regional Health Center Home Health, One Clark Bass Blvd., McAlester, OK 74501. Telephone: (918) 421-8019.]
Guidelines for Mass Influenza Vaccination Campaigns During a Delay or Shortage
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Develop liaisons with community groups representing the elderly and those with chronic diseases (e.g., offer incentives for groups to attend clinics, ask for volunteers to help promote and run clinics).
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Share information about your campaign with other clinics/facilities providing flu vaccine in your community. As needed, inform clients about other locations where vaccine is available.
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Schedule and publicize special senior clinics when only elderly or other high-risk patients will be accepted.
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Schedule flu vaccine delivery during daytime hours when the elderly, and other high-risk patients, have less need to compete with younger, healthy clients for a place in line at the vaccination location.
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Offer vaccination to elderly and chronically ill employees and relatives of employees in workplace campaigns.
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Promote the flu vaccination campaign by publishing public service announcements in local media stressing a commitment to first serve the high-risk population and asking healthy people to cooperate by waiting for availability of vaccine. Include up-to-date information about expected availability of more vaccine and about flu activity (or lack thereof) in the community.
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Share vaccine with other providers (e.g., hospitals, nursing homes, physicians) who see high-risk patients.
Vaccination Location
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Establish criteria for identifying high-risk individuals and health care workers, and give these individuals top priority when vaccine is first available.
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Provide a brief questionnaire or checklist to enable prospective vaccines to determine their risk status, and encourage those not at high risk to return in November or later.
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Post notices (or personnel) asking healthy people to defer their flu shots so high-risk people can be protected with available vaccine. Give people the opportunity to defer before they have started to wait in line.
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Establish express lanes for elderly and high-risk patients to reduce the amount of time they have to stand in line to receive the vaccine.
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Keep customers informed. Post notices informing clients of hours of flu vaccine clinics and of the need to vaccinate high-risk patients first. Establish hotlines or web sites containing relevant information. Assure customers (if appropriate) that additional shipments of vaccine are expected. Post information about other locations where vaccine is available.
Source: Centers for Disease Control and Prevention, Atlanta. www.cdc.gov/nip/flu.
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