BACKGROUND:
Influenza can be particularly hard-hitting in nursing homes. Providers and health leaders aim to immunize residents and staff and respond rapidly to outbreaks; the vaccine shortage impacted nursing homes' immunization strategies.

OBJECTIVE:
We outline decisions and concerns arising when trying to increase influenza vaccination rates among healthcare workers, despite a vaccine shortage.

METHOD:
We describe the chronological project records of ten facilities who used quality improvement methods to staff immunization in 2004-5.

RESULT:
The Veterans facilities had their influenza vaccine supplies early, for staff, residents and new admissions. The larger sites had sequential allocations for residents and then for most direct care staff. One affiliate of a chain had its supply for residents early on. Other sites gradually received supplies for most residents, with only one still having no supply at all in mid-November.
Except for the VA, none had enough to vaccinate as widely as previously. All facilities decided to immunize residents first, so half had no staff immunization in mid-November. None immunized administrative or support staff, or regular visitors.
Few facilities had previously stocked rapid test kits, but all did (except one reliant upon its local health department). Six have stocked amantadine, as in previous years. The other four are considering doing so. Ordering policies requiring unit doses, labeled per resident, generates extreme costs.
Facilities sought guidance as to prioritizing residents over staff, defining “direct” care, and deciding whether some patients were too sick. Communication with the health departments was difficult, with no established communication channels.
Findings will be updated through the conference date.

CONCLUSION:
Nursing homes this season regularly served residents first and made important decisions with inadequate data and guidance. Clearer priority guidelines and communication channels are needed during shortages.

LEARNING OBJECTIVES:
To understand nursing home experiences with influenza shortages of 2004, and to guide improvement activities.