The purpose of the 100% Immunization
Campaign is to promote immunization of older adults in
a variety of settings. For the older adults who reside
in these settings, the primary immunizations that are
needed are designed to prevent influenza, pneumococcal
disease, tetanus and diphtheria.
The primary body responsible for establishing
policies and programs in the nursing facility is the Quality
Assessment and Assurance (QA&A) Committee. Any of
the members of this committee can serve as the immunization
"champion" and begin the discussion about the
importance of having a formal immunization program within
the facility that includes all three of the needed vaccinations
for residents: influenza, pneumococcal, and tetanus-diphtheria.
In addition, the facility should have an employee immunization
program. In some larger facilities, the immunization initiative
may begin with the Infection Control Committee, which
is often a subcommittee of the QA&A Committee.
Step 1: Educate key facility staff.
The health professionals and facility
staff who especially need to be knowledgeable about immunization
issues include: the administrator, medical director, consultant
pharmacist, director of nursing, and infection control
nurse. Any of the health professionals listed above, with
adequate training and resources, can take the lead in
promoting immunization in the facility and educating the
other key players about this issue. The resources on this
web site are designed to assist in these efforts.
A variety of resource materials are
available to help in educating staff and patients about
immunization. For a listing of some useful resources,
go to: Older Adult Immunization
Resources. Included on this page are Vaccine Information
Statements from the Centers for Disease Control and Prevention
on:
- Influenza vaccine 2000-01
- Pneumococcal vaccine
- Tetanus-diphtheria toxoids
Spanish
language translations of the VIS documents are also
available on this web site.
Step 2: The Quality Assessment
and Assurance Committee should develop and approve an
immunization program for the facility.
After the members of the QA&A
Committee have been educated about the importance of having
an immunization program in the facility, the Committee
should develop and formalize an immunization program that
meets the needs of the facility. To assist in this process,
sample policies and procedures are available on this web
site. Any changes in these documents that are needed to
meet the needs of the facility residents can be made at
the discretion of the committee.
To view sample policies and procedures,
go to:
Nursing
facility immunization policy and procedure
Employee immunization program
Sample forms are also available for
use:
- Resident consent form
- Resident immunization record form
- List of residents vaccinated during
the annual influenza campaign
The above 3 forms are available for
downloading in Adobe Acrobat (PDF) format. Click here
to download PDF file: immunforms.pdf.
NOTE: Immunizations require authorization
of a physician. Before administration of a vaccine to
a resident or employee, physician authorization must
be obtained. This can be done on a case by case basis,
or preferably by each physician’s approval of the
facility standing orders for immunization.
The key points of the resident immunization
program should include:
- Residents and/or responsible parties
should be educated about immunizations upon admission
to the facility. This should include provision of a
Vaccine Information Statement for influenza, pneumococcal
vaccine and tetanus-diphtheria. See Older Adult Immunization Resources
for copies of these forms.
- After the resident or responsible
party is educated about immunizations, a consent form for all three immunizations
should be obtained from each resident upon admission
to the facility. The consent form should provide consent
for any needed immunizations either upon admission or
at any time in the future. This will preclude the need
to get a separate consent form each time an annual influenza
vaccine, or other needed immunization, is given.
- For existing residents, a similar
process of education and obtaining consent forms should
be followed when the program is initiated.
- A permanent Immunization
Record Form should be completed on each facility
resident. This form should remain in the active medical
record at all times. This provides a permanent record
of the resident’s immunization history and all
immunizations administered while residing in the facility.
- For other vaccines, there should
be a system for ensuring that each resident gets the
needed vaccines according to the recommended schedule.
The Infection Control Nurse or Immunization Coordinator
should oversee this system. The consultant pharmacist
can also review immunization records as part of the
drug regimen review process and provide feedback to
the facility.
Step 3: Immunize existing residents.
Complete an Immunization
Record Form on each existing resident. Educate
residents and/or responsible parties. Obtain consent forms
as needed. Administer vaccinations to residents who need
them, after permission is obtained from the resident or
responsible party.
NOTE: Immunization of staff is increasingly
being recognized as an important part of protecting
long-term care residents from infectious diseases, especially
influenza. Facilities should strongly encourage staff
to receive annual influenza immunizations. See "The
Importance of Staff Immunization in Long-Term Care Facilities".
Step 4: Immunize new arrivals.
As each new resident arrives, an Immunization
Record Form should be completed. Residents and/or
responsible parties should be educated about immunizations
and consent forms should be completed as part of the new
admission process. Shortly after admission, needed immunizations
should be administered when consent is obtained.
Step 5: Bill Medicare.
There should be a protocol to ensure
that billing for the vaccines, and the administration
of the vaccines, is completed accurately and in a timely
manner.
Check Older
Adult Immunization Resources for information about
billing Medicare for vaccines and the administration of
vaccines to Medicare beneficiaries.
Step 6: Evaluate the immunization
program
It is important to periodically evaluate
the effectiveness of the immunization program. The percent
of residents immunized with the three key vaccines should
be continually monitored. If a significant number of residents
are not immunized, what are the barriers? Are the facility
procedures being followed? Are residents frequently refusing
the vaccines? If so, why are they refusing?
When it is determined that the immunization
program is less than fully effective, the procedures should
be reviewed. Also review the process for educating residents
and responsible parties about immunization issues. What
improvements can be made to increase the effectiveness
of the program?
Do you have suggestions?
If you have suggestions about how
to implement an immunization program in a nursing facility,
or if you have used methods or tools that have been useful,
share your suggestions by sending an e-mail to: immunizations@ascp.com.
Useful tips and ideas will be compiled and posted on this
web site for others to learn from.
