CMS-Mandated Immunization Screening: Next Steps

Accomplishments 1.Immunization Screening section of Admit History is “smarter”. If patient has documented Pneumovax (P’Vax) or Flu vaccine: – Date(s) of vaccines display – Form remains “collapsed” so that staff do not see immunization screening questions for vaccines already completed. 2.The combined impact of Nursing Immunization Protocol and Physician “Exit Check” have helped us meet CMS benchmarks for percentage of target populations having opportunity to receive P’Vax and Flu shots.

Next Steps 1.Sept. 24 – Mar. 31: Flu screening will be added back to Admission History 2.Admission History indicators will be re- activated asap (no later than end of 2012) 3.Use new HED functionality to prompt nurses to enter VIS date, Manufacturer, Lot#, and completion of Immunization education when administering P’Vax or Flu shots. (Starts 9/24)

New Immunization fields in AdminRx

Immunization Screening: Requirements Pneumovax is recommended for all adults * over age 65 and for patients < 65 years that have risk factors. – Patients < 65 years with risk factors should have Pneumovax every 5 years – Patients 65 years or greater should have one Pneumovax (but do not need re-immunization every 5 years) Flu shots are recommended for most patients* every year immediately prior to or during Flu Season (Oct. thru April). * For both of these vaccines, there are contraindications for patients with allergies or previous reactions to the vaccine or its components. Review

Opportunities for Improvement Use nursing judgment in recording immunization history of questionable accuracy Correct Immunization Record when a P’Vax or Flu shot that has been documented in AdminRx is deleted (deleting from AdminRx does NOT automatically remove it from StarPanel Immunization Record) When Immunization screen is not completed on admission, complete as soon as possible When immunization screen is NOT indicated STOP and do NOT do further screening Details on next 4 slides

Common Issues/Solutions Documentation of prior vaccines that seem questionable (eg. Pt. < 65 w/o risk factors who reports having had Pneumovax, vaccine admin. Dates on holidays or weekends, more than one Pneumovax in a 5 year period if < 65 yrs. Or more than one after age 65, etc.) Use nursing judgment to assess validity of responses that don’t make sense. Verify with other sources when possible. Don’t document uncertified vaccines when in your judgment, the information seems incorrect. Notify provider of questionable vaccine history so they can help verify accuracy. Mark patient unable to provide history and Stop further screening. IssueSolution Users may no longer enter a free text date. When you click date box, calendar will let you select a month/year or specific date. Do NOT enter unless minimum of correct month and year are known. Month/year known but NOT date

Common Issues/Solutions (cont.) Vaccine documented on Immunization Record in error (eg. Charted in AdminRx, not given, & deleted in AdminRx but still on Immunization Record) In Immunization Record, select Show Age-View, select vaccine to be removed, click Delete, click OK, and click on New data entered – click here to save changes (see screen shots below). You may only delete vaccines you documented. IssueSolution Corrections will NOT be necessary if you follow correct steps using AdminRx: Identify pt. w/ 2 identifiers Scan med bar code Scan patient wrist band bar code Address any warnings Administer vaccine Click Confirm button to save If patient refuses before you click confirm, document reason not given – Patient refused and you will be done!

Common Issues/Solutions (cont.) Unable to obtain Immunization history on admission (ICU Patient, patient cannot provide, family not present) Patient leaves ICU, can provide, or family can provide At discharge, still unable to complete Immunization Screen Save as Draft until patient or family can provide Complete Immunization History Document Unable to complete Section 2 at this time and save Admission History as Complete. IssueSolution

Common Issues/Solutions (cont.) Doing further Immunization History when patient is Up-to-date Entering questionable uncertified vaccine when up-to-date certified vaccine already documented in StarPanel Do NOT do further Immunization screening when patient is current based on history. IssueSolution