Harmony Healthcare Blog

Immunization: What does “up to date” mean?

Posted by Pam Duchene on Fri, Jun 14, 2019


Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey

shotThe World Health Organization identifies Vaccine hesitancy as one of the top threats to global health.  While the target of education is largely centered around education for parents of young children, vaccinations for preventable disease is an important concept for all individuals.  Older adults, in particular, are at risk for communicable disease since immune systems weaken with age.  The Centers for Disease Control and Prevention (CDC) recommends the Shingles vaccine for individuals over 50 years of age, and Pneumococcal vaccines for adults over 65 and for those under 65 with certain chronic health conditions.  Specifically, the CDC recommends the following immunizations for individuals over age 65:

  • Influenza Inactivated or Influenza Recombinant:  1 dose annually
  • Tetanus, Diphtheria, Pertussis:  1 dose Tdap, then Td booster every 10 years
  • Zoster Recombinant (2 doses) or Zoster live
  • Pneumococcal Conjugate (PCV13):  1 dose
  • Pneumococcal Polysaccharide (PPSV23):  1 or 2 doses

The MDS requires assessment of vaccination status in O0250 Influenza Vaccine and in O0300 Pneumococcal Vaccine.  The MDS refers the assessor to the current version of the Resident Assessment Instrument Users’ Manual for current flu season and reporting period.  Although influenza season is generally accepted to be October 1st through the end of March, review of the RAI Users’ Manual recommends checking with the local health department for specifics on the “flu season,” since it may vary. 

The algorithm for assessment of influenza immunization status includes the following:

  • Was the vaccine received during this year’s influenza vaccination season?
  • If unknown: check with the resident
  • If the resident is unable to answer: check with the responsible party/guardian/primary care physician
  • If unable to determine the status: give the vaccine

PDPM CalculatorThere are few contraindications to the influenza vaccination.  Allergic reactions, refusals, and severe/acute illness are the only reasons to withhold the vaccination.

Answering question O0300 Pneumococcal Vaccine is a bit more complicated.  It is helpful to take a step back and review the rationale for Pneumococcal vaccination.  Pneumococcus is a leading cause of community acquired infections with the highest disease burden noted among older adults.  The Pneumococcal Vaccine is associated with reducing risk of invasive disease and pneumonia.  It is imperative for those with renal disease or with diabetes.  The MDS asks the assessor to note if the resident’s Pneumococcal vaccination is up to date.  If the Pneumococcal vaccine has not been received, the assessor documents the reason of not eligible, offered and declined, or not offered.

The algorithm for assessment of “up to date” with the Pneumococcal vaccination includes the following:

  • Is the resident’s Pneumococcal vaccination up to date?
  • If unknown: check with the resident
  • If the resident is unable to answer: check with the responsible party/guardian/primary care physician
  • If unable to determine the status: give the vaccine

The contraindications to the Pneumococcal vaccination includes:  severe allergic reaction or moderate to severe acute illness.  The MDS refers the assessor to the Advisory Committee on Immunization Practices (ACIP).  Recommendations for the Pneumococcal vaccine were published by ACIP in 2014:

  • Individuals age 65 years or older who have not been vaccinated:
  • Pneumococcal Conjugate Vaccine (PCV13)
  • Six to 12 months following the initial vaccination, Pneumococcal Polysaccharide (PPSV23)
  • Individuals age 65 years or older who have received the PPSV23 vaccination at age 65 year or older:
  • Pneumococcal Conjugate Vaccine (PCV13) one year of more following the prior vaccination
  • Individuals age 65 years who received the PPSV23 before age 65 years who are now over age 64 years:
  • Polysaccharide (PPSV23) already received at age < 65 years
  • PCV13 at age ≥ 65 years
  • Six to 12 months following the repeat vaccination, Pneumococcal Polysaccharide (PPSV23)

The Pneumococcal vaccination recommendations are complicated.  To facilitate compliance with CDC and ACIP recommendations, the CDC has created an app for providers (PneumoRecs VaxAdvisor) to quickly determine which pneumococcal vaccination the patient requires.  The app can be accessed as follows:

Although additional vaccinations such as Tdap and Shingles are also recommended for older adults, the MDS focuses on Influenza and Pneumococcus.  There is no requirement within the MDS to stretch the expectations to other vaccinations, at this point in time.  That said, however, states may impose additional expectations or requirements on compliance for SNFs regarding vaccinations.

Given the significant impact and threat of illness with influenza and pneumococcal disease, the older adult requires that the question on vaccination be taken seriously.  Following are three best practices for vaccination compliance:

  1. Verify vaccination status with the primary care provider.
  2. Document vaccination compliance and maintain a chart of compliance with dates of verification and vaccine administration in the MAR book on the Medication Cart.
  3. Document vaccination compliance and maintain record of such in the electronic health system to provide an easy way of querying the system. 

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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Topics: Immunizations

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