1. Introduction In 2005, comparisons were made internally by word of mouth and externally with other Tenet Healthcare Corporation hospitals, Georgia Hospitals and similar hospital comparison groups identifying the opportunity for improvement in vaccine administration. At that time a pilot study in a designated patient core revealed a 67% compliance rate with current vaccination procedures. Problems with influenza vaccination administration centered around ownership of the process including who was responsible for screening possible candidates and administration of the vaccine itself. Processes Atlanta Medical Center Influenza Vaccination Administration Improvement Strategy Methods A multi-disciplinary Performance Improvement Team consisting of key stake-holders in the process analyzed the following: process as designed, failure points and overall ownership of the process. Departmental responsibilities for screening and vaccine administration were assigned and root causes of failure points were identified which included breakdown of communication and lack of clear protocol procedures. Our solutions included revisions to vaccine protocols and order forms and coordination of responsibilities across departments. 2007 Multi-disciplinary team formed: Evidence Based Medicine (EBM) Committee including nursing, pharmacy, infection control, quality improvement, and Chief Medical Officer 2006 Evidence Based Medicine Coordinator hired for concurrent and retrospective reviews of the Pneumonia measures. EBM committee meets on a regular basis to discuss, plan and implement improvement strategies Sub-committee of EBM formed to discuss vaccine measures and review current practices Policy Influenza Vaccination Order form Physician, Nursing and Pharmacy Responsibilities Vaccine Administration Implementation The first vaccine order set was implemented in November 2006. It included nursing- identified indications and contraindications and also required physician order or patient refusal. The order set was updated in November 2006 to specify all vaccines given on floors to be administered 21:00 on day 2. ICU vaccines were given on day of transfer or discharge. The order form was updated once more in September 2008 to include pneumococcal and influenza on the same form. It also eliminated the requirement for a physician order or documentation of contraindications Program Progression In 2006, nurses were educated on the core measures of the vaccination program. A year later, the Nursing Admission Data Base was updated in regards to vaccines to include the statement: “Any ‘No’ answer will have Vaccination Assessment form completed or physician referral.” In 2008, Red Sheets placed on the front of charts identified Core Measure patients and requirements for nurses. The nurse would then evaluate each measure with “yes” or “no” and after, the Charge nurse would check and sign on discharge. At the end of the day, Pharmacy sent a list to the Nursing Director of all patients requiring influenza vaccine. The Chief Medical Officer also became involved by sending letters to physicians not meeting requirements. In 2009 nursing held huddles 1-2 times a day and implemented a discharge flow sheet for double check immunization status. Nursing competencies for Core Measures also included online education. In addition, nurse managers began monitoring the vaccination process. Challenges Challenges surrounding the project included ordering of the vaccine. There was a great deal of trouble in the beginning with needing a physician’s order to give the vaccine and in documenting reasons not to give the vaccine. The policy was eventually revised to allow for nurses to give the vaccine without a physician order with the Medical Executive Committee’s approval. Transfer of patients was also a problem and frequently led to a 24 hour delay as the vaccine fell off MAR after being given on day 2 on floors or in ICU on transfer or discharge. Identifying patients who have received vaccines prior to admission was also a problem as not all patients knew or could communicate if they had received vaccination. These processes were analyzed and staff educated until performance improvements were observed. Conclusions From the implementation of the program, influenza vaccination rates at AMC have risen considerably. The program offered an effective yet flexible framework within which adaptation to current challenges could take place. In the future, AMC plans to have patients screened and vaccinated on the day of admission.