title: Healthcare worker influenza declination form program.
abstract: BACKGROUND
  Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.
  
  
  METHODS
  This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.
  
  
  RESULTS
  The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.
  
  
  CONCLUSIONS
  DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.
authors: Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, General Internal Medicine and Geriatrics, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: Sherri.LaVela@va.gov.
authors: Sherri L
authors: SL
authors: LaVela
authors: Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL.
authors: Jennifer N
authors: JN
authors: Hill
authors: Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Bridget M
authors: BM
authors: Smith
authors: Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, Department of Preventive Medicine Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Charlesnika T
authors: CT
authors: Evans
authors: Department of Veterans Affairs, Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr. VA Hospital, Hines, IL; VA Spinal Cord Injury and Disorders Services, Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors: Barry
authors: B
authors: Goldstein
authors: VA Office of Public Health, Clinical Infectious Diseases, Washington, DC; Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
authors: Richard
authors: R
authors: Martinello
mesh_terms: D006282:Health Personnel / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D010561:Personnel Staffing and Scheduling; D010865:Pilot Projects; D016730:Program Development; D011446:Prospective Studies
chemical_list: D007252:Influenza Vaccines
keywords: Declination forms; Health care workers; Implementation science; Influenza vaccination