Pneumonia Vaccines 2013

Let’s Hit our Target!

Objectives

For the nurse to be able to:

• Identify why we vaccinate for pneumonia

• Recognize the patients who qualify for the vaccine

• Define the pneumonia vaccination process

• Identify where to document the vaccines and vaccine assessments

• Identify most common mistakes and the consequences of the mistakes

• Recognize the new Cerner changes

Did you know?

• Patients are screened for the Pneumonia Vaccine all year, not just during the seasonal flu time

• All patients ages 6 and above should be screened. It is not just for those age 65 and older.

FACT: Pneumonia causes more deaths worldwide than

any other infection. 1.1 million people in the U.S. were hospitalized

with pneumonia in 2009, and more than 50,000 people died from the disease

The Pneumococcal Vaccine significantly reduces the cases of pneumonia

The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS) and the CDC have created recommendations for all hospitalized patients

These recommendations are….

• ALL persons aged 65 and older should be offered the vaccine

• ALL people between ages 6 and 64 who have chronic medical conditions should be offered the vaccine

(These are your high-risk populations!)

Chronic medical conditions include:

CHF

Heart Disease

COPD

Asplenia

Asthma

Alcohol abuse

Diabetes/Gestational Diabetes

End-stage renal disease (ESRD)

Every day smoker

HIV

Sickle cell disease

Nephrotic syndrome

Who should not get the vaccine?

The following patients should not be given the vaccine:

• Those patients admitted to the ICU. The nurse should check the “N/A ICU” box

• Anyone who has had a previous reaction to the vaccine or any component of a vaccine

• Pregnant women should not get the vaccine - but they can have it post-partum if they have risk factors

Cerner Changes

There are now some new changes in Cerner

1. The pneumonia assessment will be moving from the health history to its own task at admission

2. When “unknown prior vaccine” is chosen, the vaccine will now automatically fire to the EMAR for the nurse to give – Nurses should still attempt to call the physican office to check for a prior vaccine

3. The screen will look different - there will now be a required field for the nurse to fill out risk factors (if they have any).

The new screen shots

For Patients age 65 and older:

• If they have previously had the vaccine it will show at the top –check there first.

• The old date/time box has been removed – you now must use the patient immunization tab to document their date

• You can still choose “unknown prior”, but now it will fire an order to the EMAR for the nurse to give.

For patients ages 6 to 64 with high-risk factors:

• If they have previously had the vaccine it will show at the top –check there first.

•The risk factor box has been moved and is now a required field

• Post-Partum has been added for Labor & Delivery

• The old date/time box has been removed – you now must use the patient immunization tab to document their date

• You can still choose “unknown prior”, but now it will fire an order to the EMAR for the nurse to give.

The new screen shots:

Task List – On Admission

This will be at the top of your task list

Task List – after ICU Transfer or Surgery

It will be at the bottom of your task list. NOTE: This used to be yellow

ICU Patient Admission MICU, SICU, CVSICU, CCU-ICU

• Select “N/A ICU”

• The task will then change to alert the receiving unit to re-verify once the patient leaves the ICU

• However ICU’s must address the task when the patient is discharged home from the ICU, to Psych, LTACH, or any other outlying facility

Steps for charting the Pneumococcal Vaccine

Assessment

On Step-down and Med/Surg units

Step-down and med/surg admissions • Check to see if the patient has been previously

Immunized. • Assess and chart the pneumonia vaccine by

choosing the appropriate selections • For those patients that wish to receive the

vaccine or do not remember if they have had the vaccine, it will show up to give on the EMAR on hospital day #2.

• Obtain consent as usual for those who consent to the vaccine.

• Patients may still decline the vaccine, just remember to have them sign a refusal and document declination.

Step-down and med/surg admissions (con’t.)

• If a patient is coming from the ICU or surgery/PACU, remember to complete the pneumonia vaccine task. The task will be found at the bottom of the task list.

• For Labor & Delivery, the Pneumonia Vaccine Assessment is found under the “Post-Partum Assessment” screen.

• All admission packets on each nursing unit should contain the Pneumococcal information sheet and consent/declination form.

• Patients who do not meet the age or risk factor criteria but wish to receive the Pneumonia vaccine should be educated that their insurance may not cover it. If there is doubt, have the patient sign a declination.

Location of the Immunization tab

Go to patient information and then select Immunizations

Right click your mouse to add the PPV23 vaccine

Common Mistakes Seen

• Vaccines not being re-verified after a patient is transferred to the receiving floor from the ICU’s

• Documentation of “N/A no risk factors” when a patient does have one. Check the H&P or patient history for this.

• Charting off the vaccine assessment “not done” because it’s only a seasonal assessment like flu. The pneumonia vaccine is given all year round.

• Forgetting to give the vaccine when it is on the EMAR and the patient is discharged without it.

Variances

A variance will be entered for any vaccine not administered before discharge when it was on the EMAR to give

A variance will also be entered for any patient discharged without having the assessment completed.

Remember To…

1. Re-verify the pneumonia task when a patient arrives from the ICU or Surgery/PACU.

2. If you know the date of your patient’s vaccination, enter it under the immunization tab, which is located under “patient information” in the navigator pane.

3. Remember to chart using either the original task or ad-hoc the assessment. Do not “modify” an existing assessment. This causes the med and task to not fire properly

4. Have the patient sign the refusal if they do not wish to receive the vaccine

HELP

Take a deep breath! If you have any questions call the Pneumonia Coordinator at ext. 35247 or email dcasasanta@aultman.com. She will

be happy to help you!

References

Centers for Disease Control and Prevention. (2012, November 9). Pneumonia Can Be Prevented - Vaccines Can Help. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/Features/Pneumonia/

Centers for Disease Control and Prevention. (2009, October 6). Vaccine Information Statements. Retrieved from Immunization Action http://www.immunize.org/vis