A nursing home located on an Indian reservation received technical assistance from Great Plains Quality Innovation Network (Great Plains QIN), a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), to improve its resident COVID-19 booster rate. Through strategies which support vaccination and booster clinics and engagement in a robust education and peer support network, the facility demonstrated a 29 percent increase in resident booster rates reported in the National Healthcare Safety Network (NHSN) database from when the facility was referred to Great Plains QIN for booster assistance in February 2022, through June 2022.
During initial contact with nursing home leadership, Great Plains QIN identified opportunities to build on the facility’s plans for a vaccination and booster clinic. Additional technical assistance was provided through educational materials, support resources for vaccination clinics, a webinar and peer discussion series, a nursing home peer listserv and a weekly newsletter.
Inclusive Approach, Motivational Interviewing Promote Vaccine Confidence
Great Plains QIN provides materials to nursing homes to support a culturally inclusive approach, assist with increasing vaccine confidence, and address potential COVID-19 health disparities. These resources include Tips for Reaching the Health Disparate and the Centers for Disease Control and Prevention (CDC) resource, COVID-19 Health Equity. In addition, the facility participated in a webinar on Motivational Interviewing (MI) and Great Plains QIN provided additional resources including a MI Tip Sheet and the OARS+ Model for Motivational Interviewing. Key tips from these resources include:
- Recognize and support nursing home residents’ and their families’ values, perspective, strengths and efforts
- Validate their point of view
- Foster openness and connect based on respect, not to persuade or convince
- Promote a collaborative relationship
Nursing Home Supports Staff Vaccinations and Boosters and Creates Positive Momentum
The nursing home implemented a plan to actively encourage and support staff to get their COVID-19 vaccinations and boosters. They included staff in onsite vaccination clinics to ensure easy access and offered a $500 bonus to all staff who completed a series of two COVID-19 vaccinations plus a booster. This encouraged and increased compliance and created positive momentum for staff vaccinations and boosters facility-wide. As a result of these interventions, the staff vaccination and booster rates increased from 62 percent in February 2022 to 100 percent in July 2022.
Onsite COVID-19 Vaccination/Booster Clinics Increase Rates
The facility hosted three onsite COVID-19 vaccination and booster clinics to reach both staff and residents. Great Plains QIN provides resources through its Nursing Home Vaccination Change Package. Walgreen’s Pharmacy provided the onsite vaccination clinic for staff and residents. Tribal Health subsequently provided a follow up onsite vaccination clinic to give boosters to eligible staff and residents.
Weekly Webinars, Listserv and Newsletter Reinforce Strategies
Great Plains QIN developed and hosts a weekly webinar BOOST series that includes didactic time for COVID-19 educational topics, as well as discussion time where facilities can share concerns and solutions with each other and learn from their peer network. Each week, Great Plains QIN updates the BOOST resource list with timely and relevant information on COVID-19 infection prevention and control and vaccinations and boosters from trusted sources such as CDC, the Agency for Healthcare Research and Quality (AHRQ), the American Health Care Association (AHCA), and the National Center for Assisted Living (NCAL).
Topics included by Great Plains QIN in this ongoing BOOST series included:
- Vaccination Reporting Tools
- CDC Guidance on Transmission-Based Precautions (Quarantine): Residents and Healthcare Professionals
- Vaccine Misinformation and Building Confidence in Rural Communities
- National LTC Safe Visitation Through Boosters
- OSHA Protecting Workers: Guidance and 4th Dose (Booster) Planning
- COVID Vaccination Requirements for New Staff
- Prepare for Booster Clinics – Residents and Staff
- Motivational Interviewing
- Communication Resources and Tools
- COVID-19 & NHSN Tools/Resources
- COVID-19 Vaccines: Tools for Improved Communication Can Lead to Better Understanding and Acceptance
- Long COVID or Post COVID Conditions...Best Protection is COVID Vaccines & How to Report "Up to Date" in NHSN
Great Plains QIN created a nursing home listserv that includes resources for vaccine hesitancy, along with evidence-based tools and information and active peer discussion. Over 700 nursing home members participate; conversation is very active, and the listserv provides an opportunity for Great Plains QIN to disseminate and share information, updates and guidance quickly.
The nursing home actively participates in these weekly shared learning sessions and frequently answers questions and offers advice to peers about working with individuals and communities identifying as American Indian Alaska Native (AIAN) through the GPQIN nursing home listserv.
Great Plains QIN also publishes a monthly Nursing Home Nuts and Bolts Newsletter and weekly News Posts which ensure that news, guidelines, and resources are disseminated easily and quickly.
Resident COVID-19 Booster Rate Remains High
Months after initiating their COVID-19 resident vaccination and booster efforts, the facility’s resident booster rate remains at 100 percent. Great Plains QIN continues to provide ongoing education, peer networking support, and technical assistance to facilitate the nursing home’s ongoing success.
This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-1119-07/18/2023