KEYWORDS:
immunizations, nursing homes, communication tools

BACKGROUND:
As part of the CDC/CMS SOP project participating Quality Improvement Organizations (QIOs) were asked to develop an intervention to improve the systematic immunization of patients in LTCFs. LTCFs present a number of challenges: high staff turnover, minimal training in QI principles, and time pressures.

OBJECTIVE(S):
To determine the specific steps in the immunization process in LTCFs, and develop a step-by step intervention guide to systematic immunization of patients and staff.

METHOD(S):
In 1998, MassPRO,the Massachusetts Medical Society, and Department of Public Health developed and disseminated an Employee Immunization Kit. Following this example, a workbook was constructed: a step-by-step approach to systematic immunizations, and examples of specific "tools" to assist facility staff in implementing each step, including educational material for staff and patients. The Workbook was tested, revised and sent to all LTCFs.

RESULT(S):
Presentation will describe the sections of the Workbook and how they relate to the steps LTCF staff take in implementing a systematic immunization program. Examples will be given of how LTCFs used the Workbook and the Employee Kit, and the results of a statewide assessment to determine overall impact of the Workbook in the context of the larger CDC/CMS project.

CONCLUSIONS(S):
This project has shown how to approach the development and testing of materials for quality improvement projects in LTCFs. Mindful of staff and time limitations in these settings, materials prepared should break down the change process into a series of clear, discrete and simple steps, with examples of the forms, polices, procedures and educational material that can be used at each step of the implementation process.

LEARNING OBJECTIVES:
Understand the key elements in developing a step-by-step workbook.
Understand how the workbook enables long-term care staff to follow a logical series of steps in implementing an effective immunization program.