New Federal Standards for Influenza and Pneumonia Immunizations in Hospitals, Long-Term Care Facilities, and Home Healt

1. New Federal Standardsfor Influenza and Pneumonia Immunizations in Hospitals, Long-Term Care Facilities, andHome Health Agencies Good morning/afternoon. Today, we are going to discuss how a new regulation is making it easier to administer influenza and pneumonia vaccinations and, in turn, help save lives of thousands of older Americans in hospitals, long-term care facilities and home health agencies.Good morning/afternoon. Today, we are going to discuss how a new regulation is making it easier to administer influenza and pneumonia vaccinations and, in turn, help save lives of thousands of older Americans in hospitals, long-term care facilities and home health agencies.

2. Morbidity and Mortality Influenza causes more than: 100,000 excess hospitalizations and 20,000 deaths each year S. pneumoniae infection accounts for: at least 500,000 cases of pneumonia, 50,000 cases of bacteremia and 125,000 hospitalizations each year First, I would like to start out by providing you with some background on influenza and pneumonia. Influenza and consequent respiratory diseases are common causes of unnecessary morbidity and mortality in the United States each year. <Read bullet points> First, I would like to start out by providing you with some background on influenza and pneumonia. Influenza and consequent respiratory diseases are common causes of unnecessary morbidity and mortality in the United States each year. <Read bullet points>

3. 5th leading cause of death in the United States for patients aged 65 years and older > 90% of deaths occur in those aged 65 years or older Considerable morbidity, hospitalization, and costs Vaccine Preventable DiseasesInfluenza and Pneumonia Influenza and pneumonia are vaccine preventable diseases and yet, combined they are the 5th leading cause of death among those aged 65 and older. More than 90% of all influenza and pneumonia deaths occur among those aged 65 years and older and also account for considerable morbidity rates, hospitalization and costs. Influenza and pneumonia are vaccine preventable diseases and yet, combined they are the 5th leading cause of death among those aged 65 and older. More than 90% of all influenza and pneumonia deaths occur among those aged 65 years and older and also account for considerable morbidity rates, hospitalization and costs.

4. Vaccination Reality Despite the fact that influenza and pneumococcal vaccines are: clinically effective cost effective safe, and free to most elderly patients Despite the fact that the influenza and pneumonia vaccines are clinically effective, cost effective, safe and free to most elderly patients, they are widely under-utilized. Despite the fact that the influenza and pneumonia vaccines are clinically effective, cost effective, safe and free to most elderly patients, they are widely under-utilized.

5. Barriers Contributing toLow Vaccination Rates Patient vaccination rates are often over-estimated Unknown patient vaccination status Lack of transportation Need for an appointment Patient vaccination rates are often over-estimated. Medical record review has shown actual immunization rates are lower than administrator estimates. Sometimes a patient�s vaccination status in unknown. Rather than waiting for previous medical records, it is advisable to go ahead and vaccinate, if the patient meets the screening criteria. Another barrier contributing to low vaccination rates in the 65 years and older age group is the that these patients often lack transportation necessary to reach a healthcare provider. By simplifying the administration of influenza and pneumococcal vaccines in the home, the barrier may be significantly reduced. Eliminating the need for making an advance, or follow-up, appointment for these immunizations may also increase vaccination rates. Patient vaccination rates are often over-estimated. Medical record review has shown actual immunization rates are lower than administrator estimates. Sometimes a patient�s vaccination status in unknown. Rather than waiting for previous medical records, it is advisable to go ahead and vaccinate, if the patient meets the screening criteria. Another barrier contributing to low vaccination rates in the 65 years and older age group is the that these patients often lack transportation necessary to reach a healthcare provider. By simplifying the administration of influenza and pneumococcal vaccines in the home, the barrier may be significantly reduced. Eliminating the need for making an advance, or follow-up, appointment for these immunizations may also increase vaccination rates.

6. Vaccination in Institutional SettingsA Unique Opportunity to Improve Immunization Rates In 1999 there were approximately 12.6 million hospitalizations for people aged 65 years and older. * Approximately 1.5 million residents live in more than 17,000 nursing homes in the United States** CMS data indicates there are nearly 4 million Medicare patients receiving home health care services each year. Clinicians have a unique opportunity to improve adult immunization rates and to decrease the number of deaths and complications due to influenza and pneumonia. <Please read slide text> As you can see by the numbers shown, we have a great opportunity to increase vaccination rates.Clinicians have a unique opportunity to improve adult immunization rates and to decrease the number of deaths and complications due to influenza and pneumonia. <Please read slide text> As you can see by the numbers shown, we have a great opportunity to increase vaccination rates.

7. Influenza and Pneumococcal Vaccinationin Nursing Homes 1995-1999 According to the 1999 CDC National Nursing Home Survey, you can see that immunization rates for influenza and pneumonia are well below the Healthy People 2010 goal of 90% immunization rates. Despite the fact that immunization is highly effective, 34% of all nursing home residents didn�t receive the influenza vaccine in the previous year and 62% have never been vaccinated for pneumococcal disease. According to the 1999 CDC National Nursing Home Survey, you can see that immunization rates for influenza and pneumonia are well below the Healthy People 2010 goal of 90% immunization rates. Despite the fact that immunization is highly effective, 34% of all nursing home residents didn�t receive the influenza vaccine in the previous year and 62% have never been vaccinated for pneumococcal disease.

8. Missed Opportunities With only 53.8% of older Americans receiving who had ever received a pneumococcal vaccine and 63% receiving an influenza vaccine in the past 12 months, there are many missed opportunities for immunization. With only 53.8% of older Americans receiving who had ever received a pneumococcal vaccine and 63% receiving an influenza vaccine in the past 12 months, there are many missed opportunities for immunization.

9. ��the final rule will remove the Federal barrier related to the requirement for a physician to order influenza and pneumococcal immunizations in Medicare and Medicaid participating hospitals, long-term care facilities, and home health agencies�� - Federal Register/Volume 67 No. 191, October 2, 2002 New Federal Regulation by CMS to Improve Adult Immunization Rates The Centers for Medicare & Medicaid Services and the Centers for Disease Control recognize the impact of both influenza and pneumococcal disease on the residents of long-term care, nursing homes and home health agencies. On October 2, 2002, CMS published a final rule which removes the physician's signature requirement for influenza and pneumococcal vaccinations in Medicare and Medicaid participating hospitals, long-term care facilities and home health agencies. The Centers for Medicare & Medicaid Services and the Centers for Disease Control recognize the impact of both influenza and pneumococcal disease on the residents of long-term care, nursing homes and home health agencies. On October 2, 2002, CMS published a final rule which removes the physician's signature requirement for influenza and pneumococcal vaccinations in Medicare and Medicaid participating hospitals, long-term care facilities and home health agencies.

10. Why a Change in Regulation? Increase adult immunization Decrease vaccine-preventable disease and death Simplification of the immunization process Standing orders programs are effective The new rule will change the Conditions of Participation which are federal requirements that healthcare providers must meet in order to participate in Medicare and Medicaid programs. This change will help increase adult immunization rates, decrease vaccine-preventable disease and death, simplify the immunization process and help increase adult immunizations by implementing policies to improve flu and pneumonia immunization rates. The change may also help to reach the Healthy People 2010 goal to immunize at least 90% of the institutionalized population. The new rule will change the Conditions of Participation which are federal requirements that healthcare providers must meet in order to participate in Medicare and Medicaid programs. This change will help increase adult immunization rates, decrease vaccine-preventable disease and death, simplify the immunization process and help increase adult immunizations by implementing policies to improve flu and pneumonia immunization rates. The change may also help to reach the Healthy People 2010 goal to immunize at least 90% of the institutionalized population.

11. �The new rules make it faster and easier for patients to get their flu and pneumonia vaccinations.� As Dr. Peter Houck of CMS said, �The new rules make it faster and easier for patients to get their flu and pneumonia vaccinations.�As Dr. Peter Houck of CMS said, �The new rules make it faster and easier for patients to get their flu and pneumonia vaccinations.�

12. Standing orders programs authorize nurses or pharmacists, where allowed by state law, to administer vaccinations according to an institution- or physician-approved protocol without the need for a physician�s order or signature. The Advisory Committee for Immunization Practices (ACIP) has specifically recommended that standing orders be used to increase adult immunizations. Standing orders are a type of organizational change that allow appropriate non-physician staff to offer vaccinations after assessment for contraindications, without an individual physician order according to the facility or agency policy within state and local guidelines. A finding by the RAND report found that organizational changes are one of the most effective methods in improving the delivery of preventive services. The Advisory Committee for Immunization Practices (ACIP) has specifically recommended that standing orders be used to increase adult immunizations. Standing orders are a type of organizational change that allow appropriate non-physician staff to offer vaccinations after assessment for contraindications, without an individual physician order according to the facility or agency policy within state and local guidelines. A finding by the RAND report found that organizational changes are one of the most effective methods in improving the delivery of preventive services.

13. Procedures to identify eligible patients Procedures to provide information on the risks and benefits Proper recording of refusals or contradictions Approved vaccine delivery protocol Quality assurance and documentation procedures Successful standing orders programs will include the following components: <Read bullets>Successful standing orders programs will include the following components: <Read bullets>

14. Standing Orders ProgramService Delivery Components Here is an example of how a clinician should use SOPs to administer a vaccine. Once patients who are at risk are identified, clinicians should inform patients of the costs and benefits of the disease and offer the vaccinations to those who do not have any contraindications to the vaccines. A standing orders protocol should also specify that vaccines be administered by healthcare professionals trained to screen patients for contraindications, administer vaccines and monitor patients for adverse events in accordance to state and local regulations. Here is an example of how a clinician should use SOPs to administer a vaccine. Once patients who are at risk are identified, clinicians should inform patients of the costs and benefits of the disease and offer the vaccinations to those who do not have any contraindications to the vaccines. A standing orders protocol should also specify that vaccines be administered by healthcare professionals trained to screen patients for contraindications, administer vaccines and monitor patients for adverse events in accordance to state and local regulations.

15. Who Should Receive the Influenza Vaccine? All immunocompromised patients All persons > 50 years of age Residents of nursing homes or chronic care facilities Persons with cardiovascular or pulmonary disease Persons with diabetes mellitus Patients receiving long term aspirin therapy Pregnant women who will be in the 2nd or 3rd trimester of pregnancy during flu season Healthcare workers Household contacts of persons at risk <Please read slide><Please read slide>

16. Who Should Receive the Pneumococcal Vaccine? All immunocompromised persons aged > 2 years All persons > 65 years of age Persons aged 2-64 years with: Cardiovascular or pulmonary disease Diabetes mellitus Kidney disease Alcoholism, chronic liver disease Cerebrospinal fluid leaks Functional or anatomic asplenia Or living in special environments or social settings <Please read slide> This slide and the next slide only pertain to adults and do not take into account children. <Please read slide> This slide and the next slide only pertain to adults and do not take into account children.

17. Contraindications Contraindications should be assessed prior to vaccination Few patients have true contraindications Misconceptions concerning contraindications often hinder healthcare workers from offering vaccines. These important contraindications affect only a small number of adults. Adults who need the vaccine are more likely to not be offered it because of misconceptions concerning contraindications. An important provision in the regulation change is the assessment for contraindications. This assessment should be made during the pre-vaccination screening interview and before administering the vaccine.Misconceptions concerning contraindications often hinder healthcare workers from offering vaccines. These important contraindications affect only a small number of adults. Adults who need the vaccine are more likely to not be offered it because of misconceptions concerning contraindications. An important provision in the regulation change is the assessment for contraindications. This assessment should be made during the pre-vaccination screening interview and before administering the vaccine.

18. Adverse Reactions Mild local side effect Systemic reactions such as fever and muscle aches are uncommon There are minimal adverse reactions or side effects related to the influenza vaccines because the inactivated influenza contains non-infectious killed viruses. Some recipients may experience a mild local side effect or pain and swelling at the injection site, which may persist for less than 48 hours. Some recipients experience systemic reactions such as fever and muscle aches, but this is uncommon. Lastly, I would like to point out that you cannot get the flu from the vaccine because the vaccine does not contain any live organisms. It is very important that this be explained to patients with assurance that the benefits of vaccination far outweigh the risks and that they can prevent serious illness, hospitalization and death. There are minimal adverse reactions or side effects related to the influenza vaccines because the inactivated influenza contains non-infectious killed viruses. Some recipients may experience a mild local side effect or pain and swelling at the injection site, which may persist for less than 48 hours. Some recipients experience systemic reactions such as fever and muscle aches, but this is uncommon. Lastly, I would like to point out that you cannot get the flu from the vaccine because the vaccine does not contain any live organisms. It is very important that this be explained to patients with assurance that the benefits of vaccination far outweigh the risks and that they can prevent serious illness, hospitalization and death.

19. Vaccine Effectiveness Among Older Americans in Nursing Homes Influenza vaccine (Flu shot) 40-50% effective at preventing hospitalization 80% effective in preventing death Pneumococcal vaccine up to 75% effective at preventing invasive disease It is important to note that vaccines are not harmful to sick patients, whether in the hospital, long-term care setting, or recovering at home. <Please read slide>It is important to note that vaccines are not harmful to sick patients, whether in the hospital, long-term care setting, or recovering at home. <Please read slide>

20. �A vaccine not given is  100% ineffective!�

21. Staff Vaccination Healthcare workers are a vehicle for transmitting influenza to high risk patients All healthcare workers should be immunized against influenza Influenza vaccinations protect patients and staff Reported outbreaks attributed to un-immunized staff I want to stress that immunizing healthcare workers is as important as immunizing patients. Healthcare workers are at risk for acquiring influenza and are therefore a vehicle for transmitting influenza to high risk patients. Influenza vaccinations protect patients and staff. Even nursing homes with high resident vaccination rates have had outbreaks attributed to un-immunized staff. At least two different studies have indicated that vaccination of healthcare workers has decreased death among nursing home patients. All healthcare workers should be immunized against influenza, especially those who care for high risk groups.I want to stress that immunizing healthcare workers is as important as immunizing patients. Healthcare workers are at risk for acquiring influenza and are therefore a vehicle for transmitting influenza to high risk patients. Influenza vaccinations protect patients and staff. Even nursing homes with high resident vaccination rates have had outbreaks attributed to un-immunized staff. At least two different studies have indicated that vaccination of healthcare workers has decreased death among nursing home patients. All healthcare workers should be immunized against influenza, especially those who care for high risk groups.

22. Flu and Pneumonia VaccinationsSave Lives! I want to conclude by saying that vaccinations save lives! They protect patients and healthcare workers from unnecessary illness and death. The new regulation has been implemented to simplify vaccine administration to help deliver vaccines in a timely manner, increase levels of vaccination coverage and decrease morbidity and mortality rates due to influenza and pneumococcal disease. Vaccines, when administered as part of a comprehensive Standing Orders Program, have the ability to save lives and greatly improve the quality of life for patients in institutional healthcare facilities and in non-traditional healthcare settings. I want to conclude by saying that vaccinations save lives! They protect patients and healthcare workers from unnecessary illness and death. The new regulation has been implemented to simplify vaccine administration to help deliver vaccines in a timely manner, increase levels of vaccination coverage and decrease morbidity and mortality rates due to influenza and pneumococcal disease. Vaccines, when administered as part of a comprehensive Standing Orders Program, have the ability to save lives and greatly improve the quality of life for patients in institutional healthcare facilities and in non-traditional healthcare settings.

23. For More Information