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Hitting the mark: achieving target influenza vaccination

Victoria Warmington
BSc(Hons) RGN DipDN
Research Nurse

Carolyn James
RGN BSc(Hons)
Nursing Specialist Practitioner(General Practice Nursing)
Hethersett Surgery
Norwich

Influenza is an acute viral infection of the upper respiratory tract. Patients experience a sudden onset of fever, headache, myalgia and a dry cough. Although for most flu is miserable and debilitating, it is self-limiting and is best treated with over-the-counter medicines.(1) However, for elderly people and those in high-risk groups, it can be extremely unpleasant and secondary bacterial infection can cause bronchitis and pneumonia.(2) It can therefore cause considerable mortality and morbidity, particularly in the winter months. Each year in the UK true cases of influenza cause between 3,000 and 4,000 deaths, and this figure increases up to sixfold in an epidemic year.(3)
Two years ago a major change in immunisation policy was introduced with immunisation being offered to everyone over 65. This policy remained unchanged for winter 2002/2003 but the take-up target for those eligible for vaccination has been increased from 65% to 70%.(4) The Department of Health recommends a flu vaccination for all people in high-risk groups (see Table 1). These usually take place during October and November. The vaccine is based on strains that have been predicted to be most prevalent in that season.(5)

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It is undisputed that the influenza vaccine is of benefit at an individual as well as at a community level. Influenza vaccines can be life saving and have been shown to reduce hospital admissions by up to 60% and mortality by around 40%.(6) It has been suggested that this rate could be reduced further, by up to 75%, in those who have received annual immunisations.(7) In addition, flu-related illnesses put extra strain on health and social services, which are already busy at this time of year. From September and early October each year publicity on the need for immunisation increases and consequently places extra demands on the time of practice nurses, community nurses and practice administration staff. A novel and efficient yet simple way to achieve the 70% target is described below.

How we did it
The Humbleyard Practice is semirural, with approximately 6,250 patients registered at the Hethersett site. After months of planning a flu vaccination day was set for the middle of October and was to be held in the village hall. Patients registered with the practice who were 65 and over and all patients with diabetes were invited to attend for their vaccination on the day.
In total 1,212 patients were eligible for a vaccination under the current Department of Health criteria. About 1,000 invitations were sent out to patients 4 weeks in advance of the day, as this was the maximum amount of vaccine available. Experience shows that a personalised letter from the GP is the best way of achieving a high take-up rate.(4) Patients were given a time slot of an hour in which they could come for their injection in order to stagger the workload and avoid an unnecessary wait. Patients had been asked in their invitation letter to wear short sleeves to ensure minimum undressing and ­maximum dignity.
As part of primary care's wider role in health promotion the nurse practitioner organised for representatives to set up stands in the hall offering information and advice on a number of topics pertinent to elderly people. From the local NHS trust was the glaucoma research nurse, and the rheumatology and respiratory specialist nurses. The British Heart Foundation and Social Services Contract Care also displayed information. The inclusion of these organisations was intended to make the day more health focused rather than just for the purposes of flu vaccination.
Staffing was planned carefully. The nursing complement consisted of practice nurses and community nurses as well as a health visitor. In previous years community nurses had visited sheltered housing as well as geographically isolated people in order to administer a flu vaccination. Three of the GPs from the practice attended at various times throughout the day to take part in the vaccination of patients and to offer advice if patients were unsure of their suitability for the immunisation. Practice administrative staff were on site during the whole day to hand out patient registration cards so that accurate records could be kept of who attended for immunisation. An anaphylaxis kit was kept on site in case of adverse reactions but each patient was specifically asked if they suffered from an egg allergy.
Transport was provided for those who were unable to get to the village hall through a local community transport scheme. A shuttle coach system operated to take and return residents from sheltered housing. After their injection patients were invited to stay for tea and cakes. This gave them an opportunity to socialise and catch up with old friends and acquaintances. The value of this type of interaction cannot be measured. One of the pleasures of the day was watching some of the elderly people who through frailty and/or disability do not manage to meet with their peers any more.
Inevitably costs arose from the day - the hire of the village hall, catering for those who attended at £1 per person planned for 700, carlink and the coach service. Although Hethersett and its surrounding villages are semirural transport can be a problem. The Hethersett and District Aid in Sickness Fund was established to provide assistance for those people or institutions involved in the care of the sick or infirm. This registered charity has a small fund to support local villagers but now rarely receives requests. It was therefore decided that it would benefit the community to use these funds. The charity applied for and was granted funds for a "Healthy Community Day" from the "National Lottery Awards For All", specifically to benefit the elderly due to social isolation as a result of transport problems and chronic illnesses.
A total of 702 vaccinations were administered on the day. This means that we achieved 58% of our target vaccination in one day alone. There are many benefits of this type of day for patients, general practice and community staff, as well as the NHS. The majority of those eligible can be vaccinated early in the season, thus avoiding them catching flu. This will mean a healthier winter for Hethersett and the rest of the community who are currently not eligible for vaccination under current guidelines but come into contact with those who are. The benefit to general practice is not having the nurse's clinics filled with patients for flu vaccinations during the October to December period, thus allowing their normal workload to continue.
The community nurse's workload has been reduced as a result of the "Healthy Hethersett" day. In 2001 approximately 200 flu vaccinations were given to patients in their homes and sheltered accommodation. In 2002 this number fell to 90, thus reducing their workload and transport time and costs. By achieving the 70% target for influenza vaccination, the pressures on hospital beds over winter will hopefully be decreased.

The authors would particularly like to thank the administrative staff of Hethersett Surgery for the enormous amount of work they willingly undertook to make the day such a success. Carolyn James had the initial idea for the "Healthy Hethersett" day, and so without her none of it would have happened

References

  1. Robinson E. Be aware of the ­implications of influenza. Practice Nurse 1999;18:378-8.
  2. Smyth B. Influenza surveillance: primary care has a vital role. Nursing in Practice 2002;Issue 7:85-6.
  3. Crawford M. Plan ahead for the winter campaign. Practice Nurse 1997;14:301-4.
  4. Department of Health. CMO's update 34. Influenza campaign 2002/3. London: Department of Health; 2002.
  5. Jones M. Influenza: point-of-care testing, care and treatment. Nursing in Practice 2002;Issue 7:89-90.
  6. Department of Health. Influenza immunisation programme 2001/2002. London: Department of Health; 2001.
  7. Ahmed A, Nicholson KG, Nguyen-Van-Tam JM. Reduction in mortality associated with influenza vaccination during the 1989-90 epidemic. Lancet 1995;346:591-5.

Resources
Department of Health Flu and Flu Immunisation website
W:www.doh.gov.uk/flu

Chief Medical Officer's letters - Update on Immunisation Issues
W:www.doh.gov.uk/cmo/letters/cmo0204.htm