Long-Term Care Survey Alert

With the flu season upon us, the Centers for Medicare & Medicaid Services just made it easier for nursing facilities to immunize residents against influenza and S. pneumoniae.

A final rule in the Oct. 2 Federal Register removes the federal requirement for a physician order to administer the vaccinations in nursing homes, hospitals and home health agencies, effective immediately. Instead, these providers can use a physician-approved standing order program that allows nurses or pharmacists to administer the life-saving vaccines.

According to the regulation, patient assessment is the most "vital aspect" of any standing order program. So make sure your facility performs and documents a careful assessment of residents for contraindications to the immunizations, such as a history of hypersensitivity to flu shots or other vaccines.

People with an anaphylatic hypersensitivity to vaccine components who are at high risk for flu complications can still receive flu shots, the regulation says, if they receive appropriate allergy evaluations and desensitization. Residents with acute afebrile illnesses should not receive the vaccine until they recover.

The optimal time for flu vaccination is October through November, the regulation states. The flu and pneumonia shots can be administered at the same time in different arms.

While flu shots are administered annually, people typically receive one vaccination for S. pneumoniae after age 65.

"Yet it's safe to revaccinate someone if they perhaps received the annual flu shot earlier in the flu season or if you don't know whether they have received the pneumonia vaccine," says James Marx, an infection control specialist and principal of Broad Street Solutions in San Diego. "Side effects from the vaccines are minimal," he adds.