As health care providers, we must make every effort to maximize vaccination in all adults, especially the elderly.  Each year on average in the U.S., over 40,000 adults die from vaccine-preventable diseases or their complications. Approximately 36,000 of these deaths are attributed to influenza. Nursing facilities, assisted living communities, senior centers, and adult day service centers are all settings in which older adults reside or congregate. Successful immunization programs have been implemented in all these settings.  Standing orders and universal reminders are simple and effective ways to alert the public regarding vaccinations.

Universal Strategies:

• Standing Orders
• Immunization of Health Care Professionals
• Practical Tips and Ideas

Setting Specific Strategies:

• Nursing Facilities
• Assisted Living Facilities
• Senior Centers and Adult Day Care Centeres

Standing Orders

Standing orders help to ensure the proper administration of recommended vaccines in adults as well as eliminate the need for individual physician’s orders for each patient.  These written orders stipulate that all persons meeting specific criteria (i.e. age or specific medical condition) should be vaccinated.  Standard orders are most appropriate and should be implemented in: hospitals, long term care facilities, managed care organizations, assisted living facilities, correctional facilities, home health care agencies and private practice.

Click here for more information about standing orders

 

Practical Tips and Ideas

Computerized Record Reminder:
Software can be implemented to provide patient-specific vaccination history and reminders if necessary. Once computerized system is in place, this resource can be very efficient and relatively cheap. 

Chart Reminder:
From stickers to laminated inserts, chart reminders are great ways to remind physicians about immunizations.

Mailed or Telephone Reminder:
When a patient is due for their vaccination, a simple phone call or mailed post card can provide excellent patient understanding and opportunity to schedule an appointment.

Nursing facilities

McArthur and colleagues conducted a mail survey of long-term care facilities in Canada to determine which characteristics are associated with high resident vaccination rates. The found that the following characteristics predicted success:

• A single nonphysician staff person organizing the program
• Having written policies to cover more aspects of the program
• Offering vaccine to all residents
• A policy of obtaining consent on admission that was durable for future years, rather than repeating consent annually
• Automatically administering vaccine to residents whose guardians could not be contacted for consent

McArthur MA, Simor AE, Campbell B, McGeer A. Influenza vaccination in long-term care facilities: structuring programs for success. Infect Control Hosp Epidemiol 1999; 20(7):499-503.

The Department of Health and Human Services Office of Inspector General released a report in April 2000: Nursing Home Vaccination: Reaching Healthy People Goals

The OIG report suggests that four levers of change can be influential in reaching the Healthy People 2010 objective for vaccinating nursing home residents:

• Making vaccination a standard part of admission
• Collecting uniform data on vaccination coverage
• Facilitating nursing homes’ access to vaccines
• Enhancing education about vaccine safety and efficacy

The steering committee for the 100% Immunization Campaign has developed suggested guidelines for implementing an immunization program in a nursing facility. These guidelines are designed to assist nursing facilities with incorporating these principles into a successful immunization program.

Assisted living

The steering committee of the 100% Immunization Campaign has developed guidelines for implementing an immunization program in assisted living.

Senior centers and adult day service centers

The 100% Immunization Campaign is assembling information on assisting senior centers and adult day service centers with implementing immunization initiatives. Check back at this web page later to get more information about this area.

If you have suggestions about how to implement an immunization program in senior centers, or if you have used methods or tools that have been useful, share your suggestions by sending an e-mail to: immunizations@ascp.com. Useful tips and ideas will be compiled and posted on this web site for others to learn from.