ISSUE: Immunization of the elderly is a national priority; however vaccination status can be overlooked. In an effort to increase awareness and compliance with vaccination in our long-term care residents, a vaccination task force was initiated utilizing hands-on caregivers.

PROJECT: This Veteran's Administration hospital consists of outpatient clinics, inpatient/acute psychiatric, and a 200-bed long-term care facility. In prior years, our facility had been implementing two separate immunization systems. The outpatient clinics utilized a nurse-driven protocol. Inpatients required practitioner assessment, physician order, and nursing vaccine administration. Inpatient system barriers reduced compliance rates below those in the outpatient population. Utilizing a multidisciplinary team including hands-on nursing staff, a protocol was piloted. Volunteers were solicited; training sessions were preformed on every unit for nursing and medical staff. Identifying a core group of vaccination specialists lessened the training burden. Specialists developed competency in assessment skills and charting. The protocol was trailed on all long-term care units during the September 2003–March 2004 influenza season.

RESULTS: The infection control practitioner generates a monthly report to assess the immunization needs of patients. At the beginning of this process, it was hard to ascertain who on each inpatient unit should receive notification of immunization needs. With the core group of vaccination specialists, communication efforts improved. Compliance rates increased for immunizations. On one unit, a comparison of compliance rates was examined. This unit is a long-term 36-bed care unit with a mix of palliative patients. In February 2002, a report indicated 12 patients were in need of pneumococcal immunization. Under this system, the report was sent to the practitioner. By the time she received the message and assessed, several patients were no longer on the unit. In early November 2003, the same unit report was generated. Of the 36 patients, 4 were in need of the pneumococcal immunization. Two of these had been offered the immunization and refused. This report continues to show improvement of compliance rates for immunizations.

LESSONS LEARNED: An immunization protocol is evidence-based prudent practice. Developing a cadre of unit-based vaccination specialists successfully increased vaccination rates. Frontline staff was essential.