Increasing Influenza Immunization for Long‐Term Care Facility Staff Using Quality Improvement

OBJECTIVES: To improve staff immunization rates for influenza in long-term care facilities (LTCFs). DESIGN: A quality improvement project. SETTING: LTCFs ranging in size from 50 to 2,000 beds. PARTICIPANTS: Staff members at facilities. MEASUREMENTS: Change in staff influenza immunization rate. RESULTS: Of the 13 nursing homes involved, 11 improved their staff influenza immunization rates; nine improved more than 10%, and six improved to a rate greater than 55%, a level that corresponds to substantial protection against outbreaks. Staff education was essential but insufficient. Direct encouragement and dramatic informative endeavors helped, as did financial incentives, competitions, and requiring unambiguously worded consents for refusals. Paying staff members $150 each achieved improvement rapidly. CONCLUSION: Quality improvement increased staff immunization rates at LTCFs, which reduces the risk of an influenza outbreak. Based on the insights learned about effective changes, the project developed a change package for use by other LTCFs.