Telligen’s One-on-One Technical Assistance Helps Two Nursing Homes Increase Education and Communication About COVID-19 Boosters to Improve Rates

As featured on the Quality In Action blog series.

Two nursing homes struggling to increase their resident COVID-19 booster rate were referred to Telligen, a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), for targeted technical assistance. As a result of this assistance, the facilities demonstrated a 74.9 percent and an 80.7 percent increase in resident booster rates, respectively, from when the facilities were first referred to Telligen and the last report to the National Healthcare Safety Network (NHSN) database in July 2022.

During initial encounters with both facilities, Telligen identified two challenges: 1) at the time of the referrals, resident booster shots could not be administered due to COVID-19 outbreaks and scheduled vaccine clinics had to be postponed; and 2) there was hesitancy, confusion and miscommunication around staff boosters. Both facilities chose to prioritize increasing staff booster rates, because once vaccine clinics resumed, resident concerns about receiving the booster were limited to those who were under guardianship. Both facilities were able to address concerns from guardians through education.

Sharing Educational Resources from Trusted Sources

Staff vaccine hesitancy stemmed from concerns that they had already been exposed to the virus after working in the COVID-19 unit or with COVID-19-positive patients and/or had received the initial vaccine series. Many staff didn’t feel the booster was necessary and were experiencing vaccine fatigue from being pushed to receive the shot. To address these concerns, Telligen shared the following educational resources:

• Printable posters and flyers from the We Can Do This COVID-19 Public Education Campaign including, “Give Your COVID-19 Vaccination Protection a Boost,” videos such as “Ask a Doctor: Why Is It Important to Get a COVID Vaccine Booster,” and posters from the Centers for Disease Control and Prevention (CDC), such as “Long-Term Care Facility Staff: Reasons to Get Vaccinated Against COVID-19 Today.”
• General CDC and CMS resources including COVID-19 print resources and Coronavirus (COVID-19) Partner Resources.

Encouraging Internal Communication About the Booster

Telligen also encouraged the facilities to implement tools and strategies that would improve communication with staff about the need for the booster. These included:

• The “Ask-Tell-Ask” motivational interviewing tool, an alternative approach to having meaningful conversations about vaccination and boosters without fatigue or confusion. It starts with asking someone what they know about the vaccine/booster, telling them information about the vaccine/booster and asking them how they feel about the information they received and about the questions they may have. The tool allows for empathy and acknowledgement of the other person’s situation and viewpoint, including their concerns, hesitancies and misconceptions, without overwhelming them with information.
• Peer-to-peer sharing to build staff’s receptiveness toward getting boosted. Conversations between staff and the nursing home administrator or medical director about getting the booster can be intimidating for staff. Promoting one-on-one discussions between staff about their experiences serves as positive reinforcement for getting the booster dose rather than the negative consequences of not getting boosted.

These resources and tools were also recommended to the facilities for addressing hesitancy from resident guardians.

Offering Ongoing Education and Support

In addition to the one-on-one support delivered to these facilities, Telligen’s broader strategy included offering a Give Your Nursing Home a Boost webinar series every Tuesday and Ask an Expert Q&A session on Thursdays. The Boost webinar series focuses on specific topics such as obtaining vaccine consent from families and motivational interviewing, along with tips and tricks to address common challenges. The Q&A sessions are quick, 15-30-minute meetings led by Telligen’s on-staff pharmacist and infection preventionist. Nursing homes are encouraged to come prepared to ask questions and share concerns or trends occurring in their facility. Weekly Monday emails to roughly 4,000 nursing home contacts and social media posts serve as reminders to register for these events and highlight the topics being covered. Telligen attributes both facilities’ success to the combination of direct one-on-one assistance, weekly communication, receiving resources addressing each facilities’ specific challenges and participation in the Boost webinar series and Q&A sessions.

All nursing homes in the region served by Telligen that were referred to the QIN-QIO for assistance between January 9 and July 10, 2022, saw a 25.2 percent net increase in resident vaccination/booster rates as compared to nursing homes in the state that were not referred to the QIN-QIO for assistance. In addition, the percentage of fully vaccinated and boosted residents in nursing homes in the state that were referred to the QIN-QIO for assistance, increased by 37 percent, compared to fully vaccinated and boosted residents in nursing homes not referred to the QIN-QIO, which increased by only nine percent.

Telligen Regional Nursing Home Resident COVID-19 Vaccination/Booster Rates Including Referrals from January 9 through July 10, 2022.

The graph below illustrates how vaccination rates changed following a booster rate referral. The denominator is the number of residents who have completed the primary vaccination series and received a booster. This graph only includes referrals made between January 9 and July 10, 2022, and shows how CMS-referred facilities (orange) compared to never-referred facilities (blue). Non-referred facilities did not meet initial criteria for booster referral because CMS focused on facilities with significantly lower rates.