67: Perceptions of Participating Emergency Nurses Towards an Emergency Department Seasonal Influenza Vaccination Program

Abstract

Study ObjectiveNo study has reported on the perceptions of emergency nurses towards emergency department (ED) influenza vaccination programs, a critical factor in their maintenance. Our objective was to assess the perceptions of emergency nurses who had participated in an ED seasonal influenza vaccination protocol. We hypothesized that we would be able to identify specific emergency nursing concerns about ED-based seasonal influenza vaccination programs from their experience that would be useful in improving program development and efficiency.MethodsWe conducted an anonymous Web-based survey to assess the post-participation perceptions of emergency nurses towards an ED influenza vaccination protocol during the 2009 influenza season. The vaccination protocol occurred at a tertiary, urban ED and was designed to be performed by emergency nurses without added staff resources by using clinical decision support within an existing ED computerized physician order entry system. The survey instrument consisted of nine categorical yes/no, five-point Likert scale and free-text response questions. Data from the survey was analyzed using descriptive statistics and cross-tab analysis (χ2) to assess significant correlates of where emergency nurses felt the protocol was time-inefficient. Two investigators consolidated the free-text responses of the responding nurses into categories of operational relevance.ResultsThe ED influenza vaccination protocol was in effect from October 1 to 25, 2009 with 3091 ED visits and 613 patients receiving ED seasonal influenza vaccination. 58 of 59 (98.3%) participating emergency nurses responded to the post-participation survey. 34 (58.6%) responding emergency nurses felt the protocol to be too time consuming and that influenza vaccination programs were inappropriate in the ED setting. Responding nurses reported that the clinical decision support tool in the computerized physician order entry system was easily accessed (response average of 1.70 on 5-point Likert scale (1=very easy/quick, 5=very difficult/long)) and used (response average=1.81), but time consuming both when performed by a dedicated triage nurse (response average=2.09) or by a treatment nurse triaging an ambulance arriving patient (response average=2.35). Responding emergency nurses also found providing seasonal influenza vaccination to consenting ED patients inconvenient (response average=2.70). Responding nurses reported that protocol execution could be enhanced by added staff (18.8%), simplified screening and vaccination documentation requirements (12.6%) and more efficient vaccine supply and stocking in the ED (28.0%). Cross-tab analysis found that screening tool completion time at the triage desk (χ2=10.47, p<.005) or in the patient room for ambulance arrival patients (χ2=7.78, p<.01) was most clearly correlated with the perception of time-inefficiency rather than vaccine supply/stocking issues in the ED (χ2=.57, p>.1).ConclusionSurveyed emergency nurses who had participated in an ED influenza vaccination program reported that the protocol was too time consuming and that such programs were inappropriate for the ED setting. Cross-tab analysis suggests that time in patient screening is a critical target in developing efficient ED seasonal influenza vaccination programs involving emergency nurses. Study ObjectiveNo study has reported on the perceptions of emergency nurses towards emergency department (ED) influenza vaccination programs, a critical factor in their maintenance. Our objective was to assess the perceptions of emergency nurses who had participated in an ED seasonal influenza vaccination protocol. We hypothesized that we would be able to identify specific emergency nursing concerns about ED-based seasonal influenza vaccination programs from their experience that would be useful in improving program development and efficiency. No study has reported on the perceptions of emergency nurses towards emergency department (ED) influenza vaccination programs, a critical factor in their maintenance. Our objective was to assess the perceptions of emergency nurses who had participated in an ED seasonal influenza vaccination protocol. We hypothesized that we would be able to identify specific emergency nursing concerns about ED-based seasonal influenza vaccination programs from their experience that would be useful in improving program development and efficiency. MethodsWe conducted an anonymous Web-based survey to assess the post-participation perceptions of emergency nurses towards an ED influenza vaccination protocol during the 2009 influenza season. The vaccination protocol occurred at a tertiary, urban ED and was designed to be performed by emergency nurses without added staff resources by using clinical decision support within an existing ED computerized physician order entry system. The survey instrument consisted of nine categorical yes/no, five-point Likert scale and free-text response questions. Data from the survey was analyzed using descriptive statistics and cross-tab analysis (χ2) to assess significant correlates of where emergency nurses felt the protocol was time-inefficient. Two investigators consolidated the free-text responses of the responding nurses into categories of operational relevance. We conducted an anonymous Web-based survey to assess the post-participation perceptions of emergency nurses towards an ED influenza vaccination protocol during the 2009 influenza season. The vaccination protocol occurred at a tertiary, urban ED and was designed to be performed by emergency nurses without added staff resources by using clinical decision support within an existing ED computerized physician order entry system. The survey instrument consisted of nine categorical yes/no, five-point Likert scale and free-text response questions. Data from the survey was analyzed using descriptive statistics and cross-tab analysis (χ2) to assess significant correlates of where emergency nurses felt the protocol was time-inefficient. Two investigators consolidated the free-text responses of the responding nurses into categories of operational relevance. ResultsThe ED influenza vaccination protocol was in effect from October 1 to 25, 2009 with 3091 ED visits and 613 patients receiving ED seasonal influenza vaccination. 58 of 59 (98.3%) participating emergency nurses responded to the post-participation survey. 34 (58.6%) responding emergency nurses felt the protocol to be too time consuming and that influenza vaccination programs were inappropriate in the ED setting. Responding nurses reported that the clinical decision support tool in the computerized physician order entry system was easily accessed (response average of 1.70 on 5-point Likert scale (1=very easy/quick, 5=very difficult/long)) and used (response average=1.81), but time consuming both when performed by a dedicated triage nurse (response average=2.09) or by a treatment nurse triaging an ambulance arriving patient (response average=2.35). Responding emergency nurses also found providing seasonal influenza vaccination to consenting ED patients inconvenient (response average=2.70). Responding nurses reported that protocol execution could be enhanced by added staff (18.8%), simplified screening and vaccination documentation requirements (12.6%) and more efficient vaccine supply and stocking in the ED (28.0%). Cross-tab analysis found that screening tool completion time at the triage desk (χ2=10.47, p<.005) or in the patient room for ambulance arrival patients (χ2=7.78, p<.01) was most clearly correlated with the perception of time-inefficiency rather than vaccine supply/stocking issues in the ED (χ2=.57, p>.1). The ED influenza vaccination protocol was in effect from October 1 to 25, 2009 with 3091 ED visits and 613 patients receiving ED seasonal influenza vaccination. 58 of 59 (98.3%) participating emergency nurses responded to the post-participation survey. 34 (58.6%) responding emergency nurses felt the protocol to be too time consuming and that influenza vaccination programs were inappropriate in the ED setting. Responding nurses reported that the clinical decision support tool in the computerized physician order entry system was easily accessed (response average of 1.70 on 5-point Likert scale (1=very easy/quick, 5=very difficult/long)) and used (response average=1.81), but time consuming both when performed by a dedicated triage nurse (response average=2.09) or by a treatment nurse triaging an ambulance arriving patient (response average=2.35). Responding emergency nurses also found providing seasonal influenza vaccination to consenting ED patients inconvenient (response average=2.70). Responding nurses reported that protocol execution could be enhanced by added staff (18.8%), simplified screening and vaccination documentation requirements (12.6%) and more efficient vaccine supply and stocking in the ED (28.0%). Cross-tab analysis found that screening tool completion time at the triage desk (χ2=10.47, p<.005) or in the patient room for ambulance arrival patients (χ2=7.78, p<.01) was most clearly correlated with the perception of time-inefficiency rather than vaccine supply/stocking issues in the ED (χ2=.57, p>.1). ConclusionSurveyed emergency nurses who had participated in an ED influenza vaccination program reported that the protocol was too time consuming and that such programs were inappropriate for the ED setting. Cross-tab analysis suggests that time in patient screening is a critical target in developing efficient ED seasonal influenza vaccination programs involving emergency nurses. Surveyed emergency nurses who had participated in an ED influenza vaccination program reported that the protocol was too time consuming and that such programs were inappropriate for the ED setting. Cross-tab analysis suggests that time in patient screening is a critical target in developing efficient ED seasonal influenza vaccination programs involving emergency nurses.