5. Set a goal. It may be helpful to assess your inpatient service’s demographics for the past few years to identify the approximate denominator of eligible candidates for the vaccine based on age and key diagnoses. However, if your institution does not already have a history of active influenza vaccination on the inpatient service, start with a humble goal. It is attractive to assume that every patient who qualifies will be vaccinated. It is just not so. Have your influenza committee pick an achievable goal for your first flu season and stretch it in subsequent seasons. To achieve the goal, make sure each clinical area has an identifiable “champion” who can gently remind clinicians about the importance of vaccination. The higher the profile of the local champion the better, assuming the champion has the time and can offer the effort required to do the periodic reminders. Also make sure your pharmacy tracking and distributions systems are prepared to handle the increase in requests for the vaccines. Of note, many patients who are candidates for flu shots are also candidates for pneumococcal vaccines and both may be given together. Consider adding the pneumococcal vaccine to your efforts in appropriate patients.
6. Develop an “Opt Out” system. The CDC’s Advisory Committee on Immunization Practices recommends developing standing orders for both influenza and pneumococcal vaccinations (7). In computerized order entry, this suggestion may lead to a pre-selected order-set being built into the discharge orders that requires the physician to actively opt-out of the order. Paper-based systems may include standing printed orders, again, which require a physician to decline the order specifically. Such opt out systems have been shown to improve rates of vaccination significantly (8). Opt-out programs, however, still require that the clinician ordering the vaccine discusses the vaccine with the patient before it is administered.
7. Roll it out with a bang. Make sure the commencement of your flu shot program gets some press. Announce it at departmental meetings, on system-wide emails, and in hospital publications. Remember, this program is a demonstrable way of improving your patients’ health and an excellent way for hospitalists to show their systems-oriented approaches. Begin your roll-out as early as recommended by the local Department of Public Health so that your patients, many of whom will be at very high risk for complications of the flu, get early vaccination.
8. Give frequent feedback. Obtain vaccine distribution and utilization data at least twice monthly during the first two or three months. This period corresponds to the most critical period of the program as it is when flu shots must be delivered to ensure their efficacy come December-February when flu season typically peaks (9). Some groups may find that a bit of healthy competition (e.g., between services or between nursing units) may offer that edge to keep people vaccinating. Nonetheless, it is critical to keep your clinical areas updated with their performance, with public appreciation being expressed for the top notable clinical areas and low performers receiving extra encouragement and assistance. After the first few months, monthly reports and feedback will suffice, with the program running through the end of March.
9. Remain aware of the local and national flu scene. With the vaccine production problems of the current flu season and with the panic about the high mortality rates of the Fujian strain that was not included in the vaccine last season, it is clear that the flu news scene can be volatile and controversial. It is important to remain up to date on the current facts and be able to dispel any misinformation that may circulate. The following resources may prove helpful: