OASIS Alert

OASIS C will measure and report your vaccination rates.

The 2009-2010 flu season officially begins Oct. 4, according to the Center for Disease Control and Prevention (CDC). Are you ready?

Vaccination rates will begin receiving new scrutiny as home health agencies tackle the new process measure in the OASIS C assessments. The focus in OASIS C is on seasonal flu vaccines and the pneumonia vaccine.

While the flu season has started early this year in all 50 states, most of the cases so far are of the H1N1 variety (so-called swine flu), reports Dr. Daniel Jernigan, deputy director of the influenza division at the CDC.

The CDC recommends vaccines for the seasonal flu for those 50 years of age and over, and for others with some chronic diseases, as soon as the vaccines are ready. The seasonal fluvaccine is unlikely to protect against the H1N1 virus, the agency reports, and many will need additional vaccines. Unlike seasonal flu, though, H1N1 is more of a threat to children and young adults than it is to those over 65. So adults 25 to 64 with health conditions associated with higher risk of medical complications are fifth on the list of priorities and those over 65 are last. Health care personnel should receive both vaccines, the CDC recommends.

OASIS C, which takes effect Jan. 1, 2010,asks agencies to respond to a dozen new process measures, including vaccination rates. But don't wait until January to start, says Ann Rambusch with Rambusch3 Consulting in Round Rock, Texas. It's not too early to prepare for the big change, she says (for more on developing an agency protocol, see page 100.)

M1040 (Influenza vaccine) asks if the patient received an influenza vaccine from your agency, for the current year's flu season, during this episode of care. Your answer choices are "No," "Yes," and "NA Does not apply because entire episode of care (SOC/ROC to Transfer/ DC) is outside this influenza season." For this OASIS question, CMS designates the influenza season as Oct. 1 through March 31. (For a sample form to assess a patient's need for immunization and provide follow up, see page 98.)

Problem: The clinician answers this question at either transfer or discharge, but the agency must collect this information at the start of the episode so the patient can be immunized if needed, says consultant Judy Adams with Adams Home Care Consulting in Chapel Hill, N.C. You need to identify if and when the patient received the vaccine. If the patient did not, you need to know if the patient is eligible for the vaccine, Adams explained to participants in a recent Eli-sponsored audio conference, "Home Health Boot Camp for New OASIS C Process Measures, Part 1".

Strategy: One tool could be to add this question to a letter you send to the patient's primary physician, along with other questions you may have about the patient's history. If the patient has not had the vaccine, you'll need to know if the doctor wants the agency to provide it. You'll need an order as well, Adams explained. Another idea is to add this question to the intake information so you have as much information as possible right away. Putting this information in an Excel spreadsheet would give you a record to consult now and later if the patient is readmitted, Adams suggested.

Here's how to do it: For an example of a spread sheet to track immunizations, go to www.qualitynet.org/dcs/ContentServer?c=MQTools&pagename=Medqic%2FMQTools%2FToolTemplate&cid=1200602383195.Select"Patient/Staff Tracking Record" in the righthand column.

Helpful: For information in Spanish and English to educate patients or staff, go to the CDC Web site (www.cdc.gov) and select "Vaccines and immunizations" in the right-hand menu.

OASIS C item M1045 asks why the patient did not receive the influenza vaccine during this episode of care. There are many possible reasons that won't get you in trouble. For example, the patient may have already received the flu vaccine, there may be a medical contraindication, the patient may refuse it, or you may have administered it during a previous episode.

Pneumococcal Vaccine Requires More Digging

The CDC recommends the pneumococcal polysaccharide vaccine (PPV) for all adults 65 years and older, as well as for younger patients who have a variety of health problems. Usually only one vaccination is necessary, but a patient who received the PPV before the age of 65 should receive a second dose after 65, as long as five years have elapsed since the previous dose.

Because the PPV is not administered again every year, patients and staff may have a harder time keeping track of this vaccine than they do with the flu vaccine, experts say.

If the agency did not provide the PPV during the current episode, M1055 asks why. Again, providers could have appropriate reasons this would be the case, Adams said. The patient may have already had the PPV, may not have wanted it, or may have had contraindications.

Resources: For info on CMS' expectations and reimbursement for vaccines, go to www.cms.hhs.gov/AdultImmunizations/02_Providerresources.asp. For information about preparing your agency for a flu pandemic, go to www.flu.gov/professional/hospital/homehealth.html.

Note: To attend Judy Adams' Oct. 22 audioconference that includes this topic and other process measures, go to www.audioeducator.com/conference-OASIS-C-Process-Measures-Boot-Camp-1407-0408 or call 866-458-2965.

For an immunization toolkit with extensive resources prepared by the quality improvement organization Quality Insights of Pennsylvania, go to www.qualitynet.org/dcs/ContentServer?pagename=Medqic/MQPage/Homepage, select "Home Health" in the left-hand column and the select "Immunization Toolkit" under "QIC Picks."