AGING AND DISABILITY SERVICES ADMINISTRATION

2007 NH "Dear Administrator" Letters

ADSA: NH #2007-021

Flu and Pneumonia Shot Reminders

Dear Nursing Facility/Home Administrator:

Flu and pneumonia season is quickly approaching. Residential Care Services is partnering with the Department of Health Immunization Program CHILD Profile to remind providers about the benefits of vaccinating residents and employees against the flu.

Nursing homes must meet federal and state requirements related to flu and pneumonia shots. We encourage you to start planning now for how you can protect your residents and staff against these potentially serious diseases. Vaccinating staff against the flu can help decrease the spread of flu to residents and can reduce employee sick leave.

Over 50 percent of hospitalizations and 90 percent of flu-related deaths occur among adults over age 65 years. Pneumonia kills more people every year than all other vaccine-preventable diseases combined. These shots can decrease the rate of hospitalizations and deaths, as well as improve your residents’ quality of life. Please see the attached fact sheet and resources for valuable information on flu and pneumonia shots.

Thank you for your continued commitment to nursing home residents in the state of Washington.

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services Immunization Program
Department of Social and Health Services

Janna Bardi, MPH
CHILD Profile Manager
Washington State Department of Health

Flu and Pneumonia Shots for Nursing Homes

Federal regulations regarding flu and pneumonia shots:

• In 2005, the Centers for Medicare and Medicaid Services (CMS) adopted federal regulations regarding immunizations. These regulations can be found at the following website under §483.25 - Quality of Care:
• The CMS website is the best source for accessing the most current information available. View the S&C letter at: http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter06-03.pdf

Washington State Regulation:

• Revised Code of Washington (RCW) 74.42.285 requires nursing facilities to provide a way for all residents to obtain an annual influenza vaccination and provide information on the benefits of the pneumococcal vaccination to residents that have not received the vaccine. Facilities should either provide immunizations on-site or find a community location where residents can receive their immunizations. View the RCW 74.42.285 at: http://apps.leg.wa.gov/RCW/default.aspx?cite=74.42.285.

Standing orders for immunizations:

Some facilities currently use standing orders from physicians for immunizing residents. Standing orders authorize nurses and pharmacists to administer shots according to a facility protocol without a physician’s exam. Standing orders eliminate the need to obtain physician consent every time a resident needs a shot. Facilities should always remember that:

• Residents have the right to refuse the shot; and
• Even if the resident has agreed to the immunization, the resident’s current medical status should be assessed prior to administering the shots to ensure there are no contraindications to the vaccine.

How else can I help prevent/control flu or pneumonia outbreaks?

Remind and monitor staff to assure consistent use of good infection control techniques, including proper hand washing and respiratory etiquette. The list of resources provided with this letter includes educational materials like the “Cover Your Cough” poster which shows additional ways to reduce the spread of respiratory diseases. Visitors can also spread diseases, so it is important that they understand and practice good health manners as well.

What documentation is required for flu and pneumonia shots?

CMS expects facilities to document the following information in each resident’s record:

• Provision of education on the benefits and potential side effects of each vaccine,
• Administration or refusal of the shot, and
• Contraindications to the vaccine (if there are any).

Who should be notified if multiple staff and/or residents come down with the flu?

Notify your local health department. The local health department generally will call the department’s complaint hotline at 1-800-562-6078 to report the outbreak. Find contact information for your local health department at: www.doh.wa.gov/LHJMap/LHJMap.htm.

Who should I call if I have questions?

Call your local health department if you have questions about immunizations. If you have questions about the regulations for flu or pneumonia shots or infection control please contact your RCS Field Manager.