MDS Alert

The new section requires a step-by-step process to complete correctly.

If you're still wondering what Section W2 is about or how to fill it out, you can bet surveyors will soon be on your flu immunization trail.

W2a asks you to code yea or nay whether the resident has received the flu vaccination in the facility during the defined flu season of Oct. 1 through March 31. If the answer is no (coded as a "0"), then you code one of six reasons in W2b why the facility didn't immunize the resident. That sounds simple, but there's a bit more to the decision-making maze--and you can get lost if you don't know the in's and out's.

For one, you complete W2 for all MDS assessments (PPS and OBRA-required) and discharge tracking forms with an assessment reference date (ARD) or discharge date from Oct. 1 through June 30. Section W2 is unique in that you complete the resident's vaccination status for every assessment with an ARD from Oct. 1 through June 30, noted Andrea Platt, RN, who gave a lively presentation on coding Section W, "Operation Bug," during a recent Centers for Medicare & Medicaid Services' Webcast on the subject.

Key point: Make sure all MDS assessments and discharge tracking forms with an ARD or discharge date between Oct. 1 and June 30 capture the resident's flu immunization status.
 
Example: Mrs. M received her quarterly MDS assessment on Feb. 23. She received her annual flu shot on March 10 but not within the observation period of a scheduled assessment. When the facility completes Mrs. M's MDS at the end of May, the staff will capture at W2a her March 10 flu shot, said Platt.

Don't let this confuse you:  The flu season during which the facility immunizes residents spans six months from Oct. 1 of one year through March 31 of the following year.

So if the ARD of an assessment or discharge date for the discharge tracking form is Jan. 1 through June 30, include the flu immunization administered by the facility from Oct. 1 of last year through March 31 of the current year.

Example: Mrs. T received the flu vaccine in the facility in November 2004. The ARD of this assessment is in February 2005. You would include the November 2004 vaccine by coding a "1" for "yes" in W2a.

Know When to Skip W2

If the ARD of the MDS assessment or the discharge date for a discharge tracking form occurs from July 1 through Sept. 30, skip W2.

Example: Mr. K enters your facility on Aug. 2 and receives an initial MDS assessment with an ARD of Aug. 12. Skip W2 and go to W3 (pneumococcal vaccine).

Code Why the Facility Didn't Vaccinate the Resident

If you code W2a as a "1" indicating "yes," the resident received the flu vaccine within the facility during the defined flu season (Oct. 1 through March 31), you're through with W2.

But if you code a "0" for no, you have to code W2b to explain why the resident didn't receive the vaccine in your facility.

W2b offers six coding options to explain why the resident didn't receive the flu vaccination in the facility during the current flu season:

1.  Not in the facility during this year's flu season.

2.  Received vaccine outside the facility. "This can include the doctor's office, a health fair, a hospital or fire station, etc.," said Platt.
 
3.  Not eligible [to receive the immunization]. Residents who are allergic to eggs or other vaccine components should not receive the vaccine. Acute febrile illness is another contraindication, but vaccinate the resident when the contraindication ends. The resident will also be ineligible to receive the vaccination if the physician writes an order not to immunize him, noted CMS' Mary Pratt, MSN, RN, in the Webcast.

4.  Offered and declined. That means the staff informed the resident or legal guardian about the benefits and risks of the immunization and one or the other refused it.

5.  Not offered. Say a resident enters the facility on Oct. 1, but the facility doesn't begin its annual vaccination program until Nov. 1.

On the resident's first assessment, you'd code no or "0" in W2a and select option number 5 (vaccine not offered) in W2b, advised Pratt during the Webcast.  The facility would code the resident received the vaccination in the facility, if that occurred, on his next MDS.

What if the facility offers the vaccine to a new admission but doesn't have time to vaccinate her before the 5-day PPS MDS assessment reference date? In that case, code W2a as No or "0" and check item 5 in W2b (not offered). But the facility would capture the vaccination on the next MDS or discharge tracking form.

6. Inability to obtain vaccine (due to a declared shortage). Surveyors won't cite a facility for vaccine shortages beyond its control, according to the Webcast. But the facility should vaccinate the resident once it obtains the vaccine, emphasized Webcast presenters.

Documentation tip: If the resident or his responsible party declines the vaccine, "document their refusal in the resident's clinical record," says Bet Ellis, RN, manager, LarsonAllen in Charlotte, NC. Also document facility staff's efforts to educate residents/representatives who refuse vaccination. One-to-one counseling to counter a resident's myths about flu shots has been successful in convincing even the hold outs to receive the immunization, according to Webcast presenter Susan Levy, MD.