5-Diamond Patient Safety Program

To increase the percentage of patients and staff who receive influenza vaccination.

• Complete the in-service training module on Inluenza Vaccination.
• Complete the Influenza Immunization Tracking Tool, which serves as a log of patients in the facility, identifying who received and refused seasonal flu vaccination for the current flu season.
• Complete the Log of facility staff identifying who received and refused the seasonal flu vaccine for the current flu season
• Encourage staff and patient interest by creating and displaying a large poster showing a syringe that tracks percent of patients and staff who have received vaccination.

• Discuss and implement standing orders for administering influenza vaccine.
• Display posters in waiting room, staff lounge and patient treatment area.
• Conduct one-on-one patient education about the importance of flu vaccination during scheduled treatment times.
• If you administer vaccine, use standing orders for administering vaccine and obtaining patient consent forms.
• Give your patients the quiz, Do I Need Vaccines Today?
• Provide Vaccine Administration Record to patients.

Posters:

• Flu Vaccine Facts and Myths.
• Cover Your Cough.
• Top 3 Reasons to Get Your Flu Vaccine.

Brochures and Fact Sheets:

• Influenza: Protect Yourself and Your Patients.
• Influenza (Flu) CDC Fact Sheet.

Forms and Templates:

• Immunization Checklist: Give These People Influenza Vaccine!
• Patient Quiz: Do I need any vaccinations today?
• Sample Standing Orders for Administering Influenza Vaccine to Adults.
• Vaccine Administration Record for Adults (with example record).

Reference materials:

• Medicare Immunization Billing Quick Reference Tool.
• Vaccine Handling Tips.
• Reliable Sources of Immunization Information.

• 100% of staff in-serviced on Influenza Vaccination.
• 75% of patients receive vaccination.
• 85% of faciility staff recieve vaccination.

After you have completed this module, and have documented the required measures, please submit the following documents via mail or fax.

5-Diamond Patient Safety Program
1360 Energy Park Drive, Suite 200
Saint Paul, MN 55108
651-644-9853 Fax

1. Completed Project Reporting Form.
2. In-service attendance log. (Please note that the facility in-service must be completed as a group.)
3. Log of facility staff identifying who received and refused the seasonal flu vaccine for the current flu season.
4. Completed Influenza Immunization Tracking Tool, which serves as a log of patients in the facility, identifying who received and refused seasonal flu vaccination for the current flu season.

For more assistance contact us at 5diamondsafety@nw11.esrd.net or at 651-644-9877.