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Clinical Practice Update
Vaccine Update
October 2, 2013
Patient Assessment An updated Vaccine Assessment is required for ALL patients who are admitted – o For patients under Observation status who are later admitted - the assessment is required even if patient remains boarded in an ED or PACU. Check the Immunizations Tab to see if the patient has received: o Pneumococcal vaccine any time in the past. o Influenza vaccine during the current flu season while at UMMC If patient is unable to answer (or does not remember): o Check patient’s past medical history when answering inclusion criteria for pneumococcal vaccine. o If patient unable to indicate vaccine status - ask the patient’s family or refer to documentation from other facilities.
Deferral status:
Note: deferral criteria for febrile or critically ill Shock Trauma ICU patients is only temporaryo Vaccine status must be reassessed when the patient no longer meets the deferral criteria, or prior to discharge When patient no longer meets deferral criteria, use a new vaccine assessment tool (found in Adhoc charting)
Record of Administration:
Document vaccine administration on the E-MAR as either “given” or “not given” Document a reason why the vaccine is not given on the E-mar (refused, had in the past, etc) NEW: Document the provider’s reason for temporary delay in administering vaccine in E-MAR progress note (Ad Hoc Charting). Document provider name and reason for delay. Vaccine is to be administered when criteria for temporary delay no longer applies. Ask provider to discontinue the order for vaccine if provider does not want the patient to receive the vaccine during this admission. Use the Quality Dashboard to determine if the patient has an outstanding vaccine assessment. Call the HELP desk if there are problems with the vaccine assessment tools, the vaccines on the E-MAR or problems with the vaccines column on the quality dashboard.
Please Avoid the Following:
Do not use the “No Inclusions” selection for Pneumococcal vaccine in patients who meet the age or high risk diagnostic criteria! Do not use the “Critically Ill Shock Trauma Patient” status if you are not in a Trauma ICU. Do not leave vaccine assessment deferred until discharge – vaccine status must be reassessed prior to discharge (unless patient has expired). Do not document on E-MAR that vaccine is “not appropriate at this time” – this completes the task and renders it unavailable for completion at a later time. Do not document on E-MAR that provider did not want patient to receive the vaccine. Request that they discontinue the order.
Contact Patty Dumler at pdumler@umm.edu for questions or additional information.