Improving Seasonal Flu Immunisation in the Clinical At Risk Population

NHS Greater Glasgow and Clyde

Partner organisations: Health Protection Scotland, NHS Lanarkshire

Immunisation is a critical, cost-effective element in preventing the transmission of infectious diseases. Seasonal flu immunisation is the simplest way to prevent the spread of flu.

A previous small pilot in 11 GP practices in NHS Greater Glasgow and Clyde (NHS GGC) demonstrated a small but significant improvement on flu vaccination uptake when individualised feedback to practices was provided on their last year’s performance and review of their procedures.

NHS GGC undertook a 12 month project to encourage all GP Practices with below average flu vaccine uptake to self-audit their flu vaccine processes and share and disseminate an individualized feedback report with recommendations to improve uptake. The rationale was to identify what lessons could be learned to develop a collaborative approach to improve seasonal flu uptake in future seasons.

The project was supported by grant funding from the ihub's Improvement Fund in 2016-2017.

What was the approach?

The project used a quality improvement approach (a series of Plan Do Study Act cycles) to create and refine a self-audit tool and individualised feedback report.

It’s an approach that focuses on prevention and anticipation, a component of the Scottish Government’s Health and Social Care Delivery Plan which the ihub plays a key role in supporting services to deliver.

Practices with the lowest flu immunisation uptake were identified and invited to complete the self-audit. Based on these responses, an individualised feedback report was produced for them: a simple graphic representation of the uptake for each at risk group, highlighting which populations the practice should focus on the front page, with tailored recommendations on the second to help review and revise the practice’s immunisation programme for the next flu season.
What was the impact?

Most participating practices agreed the tool and feedback report provided a focus for discussion in the practices and were eye-catching, easy to read, and relevant.

“I definitely think that doing the audit makes you self-reflect.... it tries to make you reassess, how else can we do it, what can we change that's going to bring the figures up but it also kind of made us look at what we weren’t probably doing as well as we thought we were doing. We thought we were doing a bit better than what we actually got back in the feedback”

It was easy to see areas that we needed to improve which was why I undertook the audit in the first place. It was also easy to see our good points. I would recommend rolling this out to all practices but at least one month before flu season."

- Practice Manager
What was the learning?

Collaborating and sharing widely when reviewing, planning and delivering the flu immunisation programme – with community pharmacists, healthcare support workers, local care home staff, community midwives, district nurses - encourages others to be more active advocates, which in turn increases patient attendance.

The project helped identify areas of good practice and areas for improvement, while adding to the evidence base for flu immunisation strategy on a national level.

“If nothing else, it’s just a wee reminder, because you’d start out with great intentions, I’m going to be proactive and I’m going to see all my patients getting inhalers, I’m going to say to patients on immunosuppressant’s, and you’ve got great intentions to do it and then it slips out your mind and this arrives through the door and you think, yes, I’d better go back to that.”

- Community Pharmacist
What are the next steps?

ihub funding for this project has enabled sharing of results and learning through attendance and presenting at national events, and the production of a Good Practice Guideline resource.

The guide will be shared widely among national directors, groups and forums such as the Pharmacy Division of Scottish Government, Community Pharmacy Development Team and Vaccination Transformation Programme Group.

Preliminary results have been shared as poster presentations at the NHS Scotland event, Infection Prevention Society conference and the FIP World Congress of Pharmacy and Pharmaceutical Sciences.

Ongoing discussion via the local Vaccine Transformation Board will ensure that lessons learned will be taken forward, shared nationally and contribute to the evidence base.

Evidence and Evaluation for Improvement