Download Preface - South Carolina Hospital Association

Pandemic Influenza
and
Other Mass Medical Care Incidents
with Scarce Resource Availability
Hospital Planning and Assessment Tool
April 28, 2010
1
Preface
Pandemic Influenza and Other Mass Medical Care Incidents
with Scarce Resource Availability
Hospital Planning and Assessment Tool
The development of this Planning and Assessment Tool has been funded through the 2009 H1N1
Pandemic Influenza supplemental grant provided to the South Carolina Department of Health
and Environmental Control (SC DHEC) from the Assistant Secretary for Preparedness and
Response (ASPR), Department of Health and Human Services (DHHS). This tool is intended to
provide guidance to hospitals and healthcare systems when developing or modifying their
pandemic influenza plans. It should be adapted to meet the individual organizational needs and
to supplement the organization’s Emergency Operations and Mass Casualty Plans.
This Planning and Assessment Tool is a compilation of pertinent information, some modified
specifically for South Carolina, from resources found in Appendix G of this document. For the
most up-to-date information, refer to the Center for Disease Control and Prevention (CDC)
website, http://www.cdc.gov/h1n1flu, SC DHEC website, http://www.scdhec.gov/flu/novelh1n1-flu.htm, and the South Carolina Hospital Association (SCHA) website,
http://www.scha.org.
The following organizations assisted either in the development or review of the Planning and
Assessment Tool:
• The South Carolina Department of Health and Environmental Control (SC DHEC),
• The South Carolina Hospital Association (SCHA),
• The University of South Carolina, Arnold School of Public Health’s Center for Public
Health Preparedness (USC-CPHP),
• The South Carolina Organization of Nurse Leaders (SCONL),
• The South Carolina Association for Professionals in Infection Control (SC APIC), and
• The South Carolina Healthcare Human Resources Association (SCHHRA).
The Hospital Planning and Assessment Tool Task Force members:
Jerry Anderson, MS, CFAAMA
Emergency Management Consultant
VW International, Inc.
Jane V.E. Richter, Dr.PH, MSN, MA, RN, CHES
Director, Center for Public Health Emergency Preparedness
Arnold School of Public Health
University of South Carolina
R. Bernard Chapman, Jr., MS, FAAMA
Pandemic Influenza/H1N1 Coordinator
VW International, Inc.
Contractor to South Carolina Hospital Association
Paul V. Richter, MA, FASHE, CHEP, CHSP
South Carolina Hospital Emergency Management Coordinator
VW International, Inc.
Contractor to South Carolina Hospital Association
The Task Force extends sincere appreciation to Randy Langston, Health Regulations Emergency Preparedness
Coordinator at the SC Department of Health and Environmental Control, for his careful review of, and contributions
to, this Tool.
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Leadership Responsibilities
Measures of Performance
Assessment/Action
(Compliant-3, Partially
Compliant-2, Noncompliant-1, NA-0)
Initial Planning
LD.01.01 – Ensure a work group is comprised of the following
individuals (membership may vary depending on size, location
and specialty of the organization): Chief Operating Officer,
Human Resources VP/Director, Chief Medical Officer, Chief
Nursing Officer, Chief Financial Officer, Infection Preventionist,
Risk Manager, Public Information Officer, Staff Counsel,
Employee Health Nurse, Emergency Department Director,
Emergency Management Director, Safety Officer, Security
Director, Volunteer Services Coordinator, Director of
Engineering, and Director of Materials Management.
LD.01.02 – Ensure primary and backup responsibilities have
been assigned for coordinating pandemic influenza preparedness
planning.
LD.01.03 – Ensure a process is in place for informing staff of
measures being taken to keep them safe.
LD.01.04 – Ensure conditions that are not normally considered
when developing policies but which may come in to play during
a pandemic are reviewed by the appropriate internal committees,
e.g., changes to medical care standards and activation of
alternate triage sites.
LD.01.05 – Ensure the SC Emergency Health Powers Act is
reviewed to determine and address issues in a declared
emergency related to Health Care Workers (HCWs) (e.g.,
liability, workers compensation, out-of-state licenses).
LD.01.06 – Ensure reports concerning influenza-like illness
(ILI) to DHEC per DHEC guidance are taking place.
LD.01.07- Ensure hospital critical assets are reported utilizing
the State Medical Asset and Resource Tracker Tool (SMARTT).
Incident Command
LD.02.01 – Ensure mitigation, preparedness, response and
recovery are addressed in the Pandemic Influenza Plan.
LD.02.02- Ensure Hospital Incident Command System (HICS)
positions are identified and sufficient staff identified and trained
to fill such positions.
LD.02.03 – Ensure existing policies are reviewed to see if they
address HICS.
LD.02.04 – Ensure operational periods are established when the
Hospital Command Center is activated.
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LD.02.05 – Ensure a plan for internal and external
communications (e.g., to staff, patients, patients’ families, the
public, other hospitals, appropriate DHEC Region staff, and
county emergency management agency) is developed and
utilized.
LD.02.06 – Ensure staff is informed not to talk to media directly
and refer any inquiries to the organization’s Public Information
Officer.
LD.02.07 – Ensure the hospital has specified in the Emergency
Operations Plan, and in affected policies and procedures, that it
will comply with the directions of the local, regional and/or
state-wide EOC.
Patient Flow
LD.03.01 – Ensure areas on campus are identified, outside of the
ED, where triage stations can be established.
Vaccinations
LD.04.01 – Ensure a vaccination initiative manager is identified.
LD.04.02 – Ensure a policy is developed affirming
organizational commitment to increasing vaccination rates.
LD.04.03 – Publicize senior leadership receiving vaccinations.
LD.04.04 – Ensure influential role models and champions for
vaccination initiative are identified.
LD.04.05 - Consider tying HCWs receiving vaccinations to the
organization’s code of conduct policy and the patient safety
program.
Hospital Surge
LD.05.01 – Ensure issues related to surge capacity during a
pandemic have been addressed and discussed with DHEC and
other governmental pandemic influenza planning partners (e.g.,
1135 waivers, licensing off-campus alternate care sites.)
LD.05.02 – Ensure triggers for initiating and terminating the
pandemic response operations are identified.
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Human Resources Responsibilities
Measures of Performance
Assessment/Action
(Compliant-3, Partially
Compliant-2, Noncompliant-1, NA-0)
Initial Planning
HR.01.01 - Review existing policies to see if they address:
vaccination of HCWs (to include contract staff), attendance,
cross-training, changes to job descriptions, reassignments, and
staff availability for those designated as essential personnel.
HR.01.02 - Review conditions that are not normally written in
policies but may come into play during a pandemic, such as:
compensation for working under conditions considered outside of
normal, exclusion/return to work policies, changes in work rules
for contract personnel requiring vaccinations, wearing of personal
protective equipment (PPE) and disciplinary issues for not
adhering to established guidelines, social distancing, quarantine
of staff, policy for utilization of staff outside of their normal
roles, just-in-time education/training, and ongoing employee
rights, obligations, and responsibilities before, during, and after
the pandemic.
HR.01.03 - Designate staff as essential or non-essential.
HR.01.04 - Coordinate with workers compensation insurer as to
how to report workplace-acquired influenza.
Staff Attendance
HR.02.01 - Verify staff contact information (primary and
secondary) and home addresses.
HR.02.02 - Develop a policy to deal with staff showing ILI
reporting to work.
HR.02.03 - Develop a policy, to include screening, to deal with
staff returning to work after being absent with ILI.
HR.02.04 – Develop a plan to cancel or deny staff vacation, as
appropriate.
HR.02.05 - Establish expected rates of absenteeism at the
department level, based on historical data.
HR.02.06 - Establish a policy to determine which organization is
primary when a staff member works for more than one employer.
HR.02.07 - Develop a policy to deal with staff not ill but refusing
to come to work because of a fear of exposure.
Staff Assignment/Reassignment
HR.03.01 - Assist in determination of minimum staffing
requirements and staff mix for each department.
HR.03.02 - Assist in determination of length of shifts and
personnel team rotations for each department.
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HR.03.03 - Assist in determination of which staff is capable of
working in extended or altered roles.
HR.03.04 – Provide cross training for job functions that must be
performed to maintain continuity of operations.
HR.03.05 - Assist with development of bulleted Job Action
Sheets for essential positions in business and clinical areas.
HR.03.06 - Develop a strategy to readily identify staff that can be
utilized in more than one area during the pandemic. Document
their qualifications for accrediting agencies and the Centers for
Medicare and Medicaid Services (CMS).
HR.03.07 - Assist with development of a process for rapid
credentialing of newly recruited personnel and physicians.
HR.03.08 - Assist with establishing mutual aid agreements with
other entities that may be able to share staff.
HR.03.09 - Identify staff able to work remotely from home and
ensure they have computer connectivity to perform their duties.
HR.03.10 - Assist with establishing just-in-time training for
HCWs.
HR.03.11 - Develop a policy for reassignment of high-risk staff
(e.g., pregnant personnel, immunocompromised personnel) with
consideration given to contraindications to medical counter
measures such as anti-virals, vaccines and the wearing of PPE.
HR.03.12 - Develop a policy to address payroll issues for
reassigned staff and how the various financial centers will be
charged (e.g., charge the financial center where the staff member
came from versus the financial center where they are reassigned).
HR.03.13 – Ensure the plan recognizes the need for staff rest
periods while maintaining adequate staff support.
Volunteers
Non-clinical
HR.04.01 - Assist with considering functions that volunteers can
do that are out of the ordinary for the typical hospital volunteer.
Clinical/Credentialing
HR.04.02.01 - Identify other sources for staffing (e.g. Medical
Reserve Corps [MRC], Emergency System for Advanced
Registration of Volunteer Health Professionals [ESAR-VHP]).
HR.04.02.02 - Assist with establishment of a process for
verifying credentials of all clinical staff not affiliated with the
hospital.
HR.04.02.03 - Have Job Action Sheets, just-in-time training and
orientation materials available for clinicians new to the
organization.
HR.04.02.04 – Ensure familiarization with the applicable
standards of The Joint Commission for issuing disaster privileges.
to independent healthcare practitioners.
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Work Schedules
HR.05.01 - Review policies regarding consideration of individual
religious beliefs, work availability, and staff shortages.
HR.05.02 - Ensure work schedules regarding mandatory overtime
are compliant with the State and Federal labor regulations. If not,
have process in place to request exception to policy.
HR.05.03 - Identify procedures for providing food, clothing, and
sleeping quarters for staff staying at the hospital.
HR.05.04 - Develop a policy addressing non-exempt staff
mandatory overtime and other compensation for staff remaining
at the hospital.
Isolation/Quarantine
HR.06.01 - Identify and communicate to staff what services (e.g.,
food, medicine, money), if any, will be provided when
movements have been restricted.
Employee Protection
HR.07.01 - Medically evaluate staff prior to assigning them to
tasks that require the wearing of respirators.
HR.07.02 - Consider rest periods for staff wearing respirators
recognizing that most employees will not be able to do so for
prolonged periods of time.
Telecommuting
HR.08.01 - Ensure hardware connectivity and availability of
necessary software for staff working from home.
HR.08.02 - Provide access to telecommuting staff to operational
files that directly affect their work.
HR.08.03 - Determine how telecommuting staff will record and
submit work hours.
HR.08.04 - Determine how overtime will be handled.
HR.08.05 - Develop a telecommuting agreement for employees to
sign.
HR.08.06 - Determine requirements for staff conferencing in to
meetings, briefings, etc.
Education and Training
HR.09.01 – Identify opportunities to utilize long-distance (e.g.,
web-based) and local (e.g., health department or hospitalsponsored) influenza training programs and materials appropriate
for clinical and non-clinical staff.
HR.09.02 – Identify opportunities to access alternate language
formats (i.e., prepared for individuals with visual, hearing, or
other disabilities) and reading-level appropriate materials for
clinical and non-clinical staff to supplement and support
education and training programs.
HR.09.03 – Provide education and training on the hospital’s
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pandemic influenza plan, including relevant personnel policies,
and operational changes that will occur once the plan is
implemented.
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Infection Prevention and Control Responsibilities
Measures of Performance
Assessment/Action
(Compliant-3, Partially
Compliant-2, Noncompliant-1, NA-0)
Initial Planning
IC.01.01 – Employ a reliable and valid method for conducting
syndromic surveillance for persons with ILI and reporting to
DHEC utilizing the South Carolina Aberration Alert Network
(SCAAN).
IC.01.02 – Designate a person with responsibility for
coordinating education and training on pandemic influenza.
IC.01.03 - Plan to have educational/directional posters or signs
where HCWs enters the building and where they gather
frequently (e.g., time clock, cafeteria, break rooms, nurses’
stations).
IC.01.04 – Consider screen savers or other means of providing
reinforcements for hand hygiene, cough/sneeze etiquette,
receiving vaccinations, not working when sick with ILI, etc.
Medical Countermeasures: Antivirals/Vaccines
IC.02.01 – Convene a multidisciplinary taskforce to determine
vaccine and antiviral allocation plans in accordance with
CDC/DHEC guidance.
IC.02.02 – Establish relationship with DHEC regional staff to
ensure that adequate influenza vaccine and antivirals are
available for staff.
IC.02.03 – Determine HCWs to be included in vaccination
initiative with consideration of direct care providers,
ancillary/support staff, agency staff, volunteers, students,
attending physicians, contract staff, etc.
IC.02.04 – Develop a multi-faceted campaign to educate staff on
the benefits of receiving vaccine.
IC.02.05 - Plan to measure outcomes of vaccination campaign to
assess success of initiative.
IC.02.06 – Develop a real time database to track vaccination data
for HCWs having contact with patients.
IC.02.07 – Consider requiring HCWs that refuse vaccine to sign
a declination statement that explains the consequences to staff
and patients that may result from the refusal.
IC.02.08 – Develop a plan for surveillance and detection of
pandemic influenza in hospital patients and staff so data validates
vaccination efforts.
Isolation/Quarantine
IC.03.01 – Consider a policy that defines and operationalizes
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quarantine, home quarantine and work quarantine.
IC.03.02 – Identify areas to post signage identifying isolation/
quarantine areas.
Employee Protection
IC.04.01- Plan for the availability of proper PPE for HCWs and
patients (refer to CDC, DHEC, and SCHA websites for the latest
guidance).
IC.04.02 – Ensure that fit testing for appropriate PPE is
accomplished.
IC.04.03 – Ensure proper hand hygiene, respiratory hygiene and
cough etiquette are taught and practiced.
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Provision of Care Responsibilities
Measures of Performance
Assessment/Action
(Compliant-3, Partially
Compliant-2, Noncompliant-1, NA-0)
Initial Planning
PC.01.01 – Review existing policies to see if they address
patient/nurse ratios.
PC.01.02 – Review unusual conditions not normally in policies
but that may come into play during a pandemic, such as: patient
flow, test/procedure ordering (e.g., ordering of PCRs), admission
or discharge criteria and shortages of supplies and equipment and
pharmaceuticals.
PC.01.03 – Increase par levels of PPE and pharmaceuticals.
PC.01.04 – Review, and if necessary, modify administrative and
clinical issues to cope with surge of patients and the demand for
resources.
PC.01.05 – Ensure there is a plan for use of antivirals.
PC.01.06 – Ensure the conservation and allocation of scarce
resources.
PC.01.07 – Ensure the involvement of the ethics committee, as
appropriate.
PC.01.08 – Train physicians, physician assistants and appropriate
nursing personnel as Triage Officers utilizing triage strategies and
prioritizing patients using the Sequential Organ Failure
Assessment (SOFA) methodology.
PC.01.09 – Develop a plan in coordination with local
coroners/medical examiners and morticians for postmortem care
temporary morgue to manage the disposition of deceased patients.
Alternate Triage Sites
PC.02.01 – Determine staffing, equipping and supply needs for
areas identified as on-campus alternate triage sites.
PC.02.02 – Identify appropriate patient flow through the alternate
triage sites and plan for appropriate directional signage.
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Environment of Care Responsibilities
Measures of Performance
Assessment/Action
(Compliant-3, Partially
Compliant-2, Noncompliant-1, NA-0)
Patient Flow
EC.01.01 - Ensure there is re-directional signage for when the
hospital is in controlled access mode.
EC.01.02 - Determine the signage that will be posted at entrances
to direct patients with ILI to proper areas that will reduce
exposure to non-exposed staff and patients.
Alternate Triage Sites
EC.02.01 - Determine if the alternate triage site has appropriate
air flow to prevent the spread of the influenza virus. If not
sufficient, explore the availability of portable high-efficiency
particulate air (HEPA) filtration devices.
EC.02.02 – Ensure the alternate triage site(s) are appropriately
equipped, i.e., HVAC, water, sewer, electrical including
emergency power, telephone, inter/intranet connectivity, and
other communication devices.
Safety and Security
EC.03.01 – Develop a plan for hospital access during a pandemic
that includes criteria and protocols for limiting or restricting
visitors to the hospital, including specific plans for
communicating with patients’ families about hospital rules for
visiting hospitalized family members.
EC.03.02 –Request, as appropriate, quarantine orders from DHEC
and coordinate enforcement with local law enforcement and
hospital security.
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Appendix A
Employee Staffing Planning Tool
In order to effectively plan for a potential staffing crisis due to a pandemic, please provide the
information below.
Name: ________________________________________________
Employee ID number or Date of Birth: ______________________
Department: ___________________________________________
Contact information:
Address: ____________________________________________________________
Street
City
Zip
Home phone: _______________________ Cell phone: _______________________
In order to assist us in our efforts to obtain sufficient quantities of protective measures (if
available):
Household size:
_________ Number of children
_________ Number of adults
I may have difficulty being able to come to work during a pandemic because:
□ I provide care for an immediate relative who is elderly or for an immediate relative
who is handicapped, has a chronic illness or who cannot care for himself/herself.
□ There are no other adult family members to provide care.
□ I will need help with establishing alternate care arrangements.
□ I have a dependent child.
□ There are no other adult family members to provide this care.
□ Parents work for the same hospital (request reassignment for one).
□ I will need help with establishing alternate care arrangements.
□ I have pets that will require care.
□ I have no known issues at this time and will be available to work during a pandemic.
_______________________________________
Signature
_________________________
Date
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Appendix B
Competencies Self-Assessment
* An adaption of the Ontario Health Plan for an Influenza Pandemic; July, 2007
Patient Care:
I have clinical experience in:
I am competent in:
Hospital
Adult ICU
Pediatric ICU
Neonatal ICU
Step-down Unit
General Ward
Emergency Department
Rehab Services
Palliative Care
Out-patient Clinic
Other
Administration
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
□ No
Long-term Care
Chronic Care Hospital
Residential
Day Care
Hospice
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
□ Yes
□ Yes
□ Yes
□ Yes
□ No
□ No
□ No
□ No
Community
Private Office
Home Health
Family Physician Office
□ Yes □ No
□ Yes □ No
□ Yes □ No
Other Health Care Setting
Public Health
Pharmacy
Laboratory
Rural/Isolated Areas
□ Yes
□ Yes
□ Yes
□ Yes
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ No
□ No
□ No
□ No
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Appendix C
Department Staffing Needs Checklist
Name: _____________________________________________
Date: __________________
Department: _________________________________________
Identify the minimum number of staff and the staffing mix required to maintain operations
within your department.
Required Skills
Number of Employees/Shift
7-3
3-11
11-7 7a-7p 7p-7a
Identify staff that could possibly work remotely.
Name
Title
Skills
Shift
Identify computer resources that would be required for employees to work remotely.
Name
Title
Hardware Needs
Software Needs
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Appendix D
Sample Telecommuting Policy
The employee voluntarily agrees to work at the hospital’s approved alternate workplace
indicated below and to follow all of the organization’s applicable policies and procedures. This
is not considered an employee benefit but an additional method of accomplishing work. This
approved alternate workplace shall be designated as the employee’s official duty station until
otherwise designated by hospital leadership.
The official duties shall be the same as those expected of the employee at his/her hospital place
of work. The work schedule shall be determined by the employee’s supervisor and may vary
based on degraded working conditions brought on by the incident. Time and attendance shall be
accounted for by a system determined by the staff member’s supervisor. The employee shall be
responsible for sending an email to their supervisor designating times when they begin work and
when logging off the clock. The employee will also be responsible for submitting a consolidated
time sheet on normal days of submittal.
Salary and benefits will not change due to working at the alternate workplace. Overtime, for
those eligible, will be calculated as it is normally done. All leave and vacation will be
suspended, unless otherwise approved after the incident, is declared by the employee supervisor.
The employee shall utilize his/her own computer if available. Should one be needed, the
employee may borrow one from the hospital, if available and if coordinated through the
supervisor through the IT Department. Any software required for the accomplishment of the
duties of the employee shall be provided by the hospital. The employee shall utilize all security
means possible to protect patients’ and organization’s information. The employee shall be
responsible for compliance of those applicable sections of the Hospital Insurance Portability and
Accountability Act (HIPAA).
Work from the alternate workplace shall be terminated when it is determined by hospital’s
leadership that employees should return to their normal duties within their department. All
borrowed equipment will be returned at that time and patient and hospital sensitive information
shall be removed from the employee’s computer as appropriate.
___________________________________________________________________________
Alternate Workplace to include address and telephone number
________________________________ ________________
Employee’s Signature
Date
________________________________ ________________
Supervisor’s Signature
Date
________________________________ ________________
Human Resources’ Signature
Date
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Appendix E
Influenza Care Competencies for Staff
*An adaptation of the Ontario Health Plan for an Influenza Pandemic; July, 2007
Organizational
Area
Administration
Education
Infection Control/
Employee Health
Care for well staff
Competencies
A. Management/leadership
1. Ability to respond to crisis, develop strategies for response.
2. Hospital management skills.
3. Organizational staffing for particular situations.
4. Scheduling and deployment of staff, supplies and equipment.
5. Succession and contingency planning.
6. Incident command knowledge.
B. Communication
1. Coordination with other hospitals.
2. Coordination with ESF-8 lead.
3. Internal communications.
A. Ability to educate healthcare professionals about:
1. Pandemic influenza preparations.
2. Personal and family preparedness.
3. Self screening for influenza like symptoms and for stress.
4. Normal triage and Triage Officer training.
5. Assessment using current protocol.
B. Ability to educate the general public about:
1. Influenza self care.
2. Hand washing.
3. Social distancing.
4. Cough and sneeze etiquette.
5. Home quarantine and isolation.
6. Vaccines and anti-virals.
A. Ability to screen staff for illness.
B. Ability to identify staff that through illness or burn out, needs assistance
or rest.
C. Ability to implement surveillance programs and report to public health.
1. For disease impact.
2. For adverse events from immunizations and/or treatments.
D. Ability to monitor workplace and patient safety.
E. Ability to obtain support for staff (e.g., psychological).
A. Immunization
1. Ability to screen for eligibility for immunization.
2. Ability to obtain consent for immunization.
3. Ability to prepare vaccine for injection and inject vaccine.
B. Prophylaxis
1. Ability to screen for eligibility for anti-viral prophylaxis.
2. Ability to obtain consent for anti-viral prophylaxis.
3. Ability to prescribe anti-viral prophylaxis for prevention of influenza.
4. Ability to dispense anti-virals for prevention of influenza.
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Influenza Care Competencies for Staff
Page 2
Organizational
Area
Care for ill patients
Competencies
A. Competencies across care settings
1. Taking a medical history.
2. Examining the lungs.
3. Performing a complete physical exam.
4. Interpreting the results of history, physical exam, chest x-ray, laboratory
and point of care testing.
5. Prescribing medications.
6. Triaging patients to the appropriate location and level of care
7. Ability to recognize when to refer patient to a higher level of care.
8. Discharging patient to home or other care setting.
9. Ability to make the decision when palliative care/withdrawal of care is
appropriate.
10. Ability to certify death.
11. Identifying psychosocial support needs.
B. Technical skills
1. Acute care: measuring temperature, pulse, blood pressure, taking
blood, obtaining nasal swabs, obtaining other culture, performing IM
injections, starting and maintaining intravenous lines, setting up
oxygen for administration and checking administration,
administrating oral, inhaled, IV, and IM medications, suctioning
non-intubated and trachea patients, insertion and maintenance of
Foley catheters.
2. Long-term care: all acute care competencies plus applying intubation,
ventilation, central and arterial lines insertion and maintenance,
suctioning, ACLS, management of inotropes and vasopressors,
management of insulation infusion, management of dialysis.
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Appendix F
Strategies to Increase Vaccination Rates
A. Provide Incentives
 Use contests and competitions to “brand” the campaign initiative by soliciting ideas for slogans,
jingles, videos (watch the one developed in 2008 at the Hospital of the U. of Penn, Baby Be
Wise—Immunize: http://www.youtube.com/watch?v=ruGgZbAVnko)
 Organize a multifaceted campaign around a theme or slogan to market the effort
o Develop campaign materials using readily-identifiable HCWs to promote messages
o Recognize those receiving vaccinations with buttons/stickers for id badges
o Have t-shirts, lanyards, caps, etc. to identify immunized HCWs
o Award prizes/rewards: coupons for discount purchases, dress-down days, nominal gifts
(e.g., notepads, t-shirts), financial discounts on benefits, raffle tickets, movie tickets,
tailgate party, etc.
o Begin the campaign with several round-the-clock blitzes to rapidly increase proportion of
HCWs that are vaccinated
o Post vaccination rates by units to spur competition
 Acknowledge the decision to/not to receive vaccinations when giving merit raises or doing
performance reviews
 Report employee vaccination rates to board, administration, and public as a quality indicator of
dedication to patient safety
 Subsidize vaccinations for family members, as able/appropriate
B. Provide Education
Utilize salient educational messages that convey the fact that vaccinations aren’t encouraged,
they’re expected!
 Flu vaccinations decrease sickness & death of high-risk patients
 Flu vaccinations decrease absenteeism (and time off can be used instead for enjoyable things)
 Flu vaccinations protect patients & family members
 Flu vaccine is safe
 Other mandatory programs exist and are effective (Hepatitis B series, TB skin tests, etc.)
 Vaccination rates are not increasing substantially even after x number of years so may need to
make mandatory through hospital policy rather than have an outside entity stepping in
 Go home/stay home when have influenza-like illnesses (ILI)
 Tailor messages to various groups (based on reasons for declination in previous season or
concerns circulating on the grapevine)
Utilize a variety of avenues to educate
 Solicit help of OB/GYNs to promote vaccinations for pregnant women
 Use the “personal touch” in addition to print materials
 Use banners to promote campaigns
 Provide emails and reminders
 Publish a series of articles about vaccination initiative in newsletters
 Hang posters
 Put screen savers on computers
 At meetings stress importance of vaccination initiative
 Work with attending physicians and house staff to encourage them to promote flu vaccine(s)
19

Have organizational leaders receive their vaccinations and publicize the event
C. Use Sanctions
 Require one-on-one educational contact for those choosing to decline vaccination
 Require a formal declination
o Consider allowing refusal for only medical or religious reasons
o Require reason for declining—can be a checklist or write in
o Include statement that education has been provided
o Include statement that refusing the vaccination puts “your patients” at risk
o Include statement about the importance the organization places on vaccinations
o Include any consequences from refusing the vaccinations
OR
 Require that HCWs wishing to decline a vaccination submit in writing a “request for
accommodation “ that is evaluated and responded to on a case-by-case basis
 Consider requiring the wearing of a mask for duration of flu season if vaccination declined
 Consider restriction of work area(s) if vaccination declined
 Use on-line, self-report of vaccination status to track non-vaccinated employees
D. Decrease Barriers
 Use enough vaccinators to keep wait times to a minimum
 Offer vaccine(s) free of charge
 Use mobile carts
 Use peer vaccinators
 Use roving vaccination teams
 Go to out-lying buildings on campus to offer vaccinations
 Provide vaccinations for all shifts and on weekends
 Allow for walk-ins as well as appointments to receive vaccine(s)
 Offer vaccinations around departmental meetings, in-services, skills check offs, OSHA
requirements
 Offer vaccinations to new employees at time of post-offer physical
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Appendix G
Resources
Organization
Department of Health and Human
Services, Pandemic Influenza Plan
Centers for Disease Control and
Prevention, Hospital Pandemic
Influenza Planning Checklist
Centers for Disease Control and
Prevention, Interim Guidance on
Infection Control Measures for 2009
H1N1 Influenza in Healthcare
Settings, Including Protection of
Healthcare Personnel
Centers for Disease Control and
Prevention, Vaccination Information
for Clinicians and Health Care
Professionals
Centers for Disease Control and
Prevention
United States Department of
Homeland Security, Pandemic
Influenza Preparedness, Response,
and Recovery: Guide for Critical
Infrastructure and Key Resources
Occupational Health and Safety
Administration (OSHA), Pandemic
Influenza Preparedness and
Response Guidance for Healthcare
Workers and Healthcare Employers
Occupational Health and Safety
Administration (OSHA), Guidance
on Preparing Workplaces for an
Influenza Pandemic
Department of Health and Human
Services, Centers for Medicare and
Medicaid Services, 2009-H1N1
Influenza Pandemic Section 1135
Waiver Memorandum
Department of Health and Human
Services, Centers for Medicare and
Medicaid Services, Emergency
Medical Treatment and Labor Act
(EMTALA) Requirements and
Website
http://www.hhs.gov/pandemicflu/plan/sup3.html
http://www.cdc.gov/flu/pandemic/pdf/pandemicfluchecklist.p
df
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
http://www.cdc.gov/h1n1flu/vaccination/professional.htm
http://www.cdc.gov/h1n1flu/
http://www.ready.gov/business/plan/influenza.html
http://www.osha.gov/Publications/3328-05-2007English.html
http://www.osha.gov/Publications/OSHA3327pandemic.pdf
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downlo
ads/SCLetter10_06.pdf
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downlo
ads/SCLetter09_52.pdf
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Options for Hospitals in Disasters
American Health Lawyers
Association, Health Lawyers’ Public
Information Series, Emergency
Preparedness, Response & Recovery
Checklist: Beyond the Emergency
Management Plan
The Joint Commission, Providing a
Safer Environment for Health Care
Personnel and Patients Through
Influenza Vaccination
2009 South Carolina Emergency
Management Division (SC EMD),
South Carolina Emergency
Operations Plan, Appendix 5-SC,
Annex 2, Pandemic Influenza
Society for Human Resource
Management, Doing Business
During an Influenza Pandemic: A
Toolkit for Organizations of All
Sizes, November 2009
Association for Professionals in
infection Control and Epidemiology,
Reuse of Respiratory Protection in
Prevention and Control of Epidemicand Pandemic-prone Acute
Respiratory Disease (ARD) in
Healthcare
South Carolina Department of
Health and Environmental Control
South Carolina Pandemic Influenza
Ethics Steering Committee, White
Paper
South Carolina Hospital Association
SC Emergency Health Powers Act
State Medical Asset and Resource
Tracker Tool (SMARTT)
The Center for Infectious Disease
Research and Policy (CIDRAP) and
Society for Human Resource
Management (SHRM), Doing
Business During an Influenza
Pandemic
Occupational Health and Safety
Administration (OSHA),
http://www.healthlawyers.org/Resources/PI/InfoSeries/Docu
ments/Emergency Preparedness Checklist.pdf
http://www.jointcommission.org/Library/Publications/flu_mo
nograph.htm
http://www.scdhec.gov/administration/ophp/docs/PandemicInfluenza-Mass-Casualty-Plan-Annex-2.pdf
http://www.shrm.org/about/pressroom/PressReleases/Pages/N
ewFluGuide.aspx
http://www.apic.org/Content/NavigationMenu/EmergencyPre
paredness/PositionPapers/Reuse_of_Respirators.pdf
http://www.scdhec.gov/
http://www.scdhec.gov/administration/ophp/pandemicethics.htm
http://www.scha.org
http://www.scstatehouse.gov/code/t44c004.htm
https://apps.emspic.org/SMARTT/Go
http://www.emspic.org/?q=node/7 (for general information)
http://www.cidrapsource.com
http://www.osha.gov/OshDoc/Directive_pdf/CPL_02_0222
Enforcement Procedures for High to
Very High Occupational Exposure
Risk to 2009 H1N1 Influenza
Institute of Medicine, Guidance for
Establishing Standards of Care for
Use in Disaster Situations
Agency for Healthcare Research and
Quality, Mass Medical Care with
Scarce Resources: The Essentials
075.pdf
http://www.iom.edu/CMS/3740/72417/73609.aspx
http://www.ahrq.gov/prep/mmcessentials/
23