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Be Prepared for the Coming Flu Season

By Linda Day, RN, BSN, MBA, Quality Improvement Project Supervisor, and Robert A. Feigenbaum, MS, Editor

Flu season is fast approaching and healthcare providers are in an excellent position to ensure home health care patients receive influenza vaccine. The Centers for Disease Control and Prevention (CDC) estimates that each year the flu and its complications cause 36,000 deaths and 200,000 hospitalizations. In Ohio, pneumococcal pneumonia causes more than 3,000 deaths annually, placing flu and pneumonia among the top 10 causes of death in the state.

Who should be vaccinated?

According to flu vaccine makers, 100 million doses of the vaccine—16 percent more than last season—will be available in this country for the 2006-2007 flu season. The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends the following individuals receive a flu vaccine:

• Children 6-59 months
• Women who will be pregnant during the influenza season
• Persons aged 50 or older
• Children and adolescents (aged 6 months to 18 years) who are receiving long-term aspirin therapy
• Adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including asthma (hypertension is not considered a high-risk condition)
• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunodeficiency (including immunodeficiency caused by medications or immunodeficiency virus)
• Adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions, or that can increase the risk of aspiration
• Residents of nursing homes and other chronic care facilities that house persons of any age who have chronic medical conditions
• Persons who live or care for persons at high risk for influenza-related complications, including healthy household contacts and caregivers of children aged 0-59 months
• Healthcare workers

Cautionary note: The nasal flu vaccine (known as LAIV or Live Attenuated Influenza Vaccine) is approved for use in healthy people 5 to 49 years of age who are not pregnant.

Who should not be vaccinated?

Some people should not be vaccinated without first consulting a physician. They include:

• People who have a severe allergy to chicken eggs
• People who have had a severe reaction to an influenza vaccination in the past
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously
• Children less than 6 months of age
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen

Healthcare workers

Healthcare workers (HCWs) are included in the Advisory Committee on Immunization Practices’ (ACIP) list of those who should be vaccinated with the flu vaccine. Many HCWs work while sick, according to Richard K. Zimmerman, MD, MPH, of the University of Pittsburgh Department of Family Medicine and Epidemiology. Dr. Zimmerman noted one study found that nearly 25 percent of HCWs had serologic evidence of influenza infection. However, most—59 percent—could not recall being sick, suggesting asymptomatic influenza.

Dr. Zimmerman also noted that healthcare workers who get vaccinated uphold the ethical code of “first do no harm.” He pointed out that reduction in outcomes due to healthcare worker vaccination were as follows: influenza infection of HCWs 88 percent; sick days for HCWs due to respiratory infection, 28 percent; days lost from work for HCWs, 41 percent; and patient mortality, 40 percent. Unfortunately, the rate of vaccination for HCWs is low. In 2003, the National Health Interview Survey (NHIS) reported that only 40 percent of HCWs were vaccinated.

How to increase vaccination rates

One of the national health objectives is to achieve vaccination coverage for 90 percent of persons 65 years of age and older by 2010. In this age group, flu vaccination levels increased from 33 percent in 1989 to 66 percent in 1999. It has remained relatively stable since 2000. In addition, there continues to be a racial disparity with respect to flu vaccination. Estimated vaccination coverage levels based on 2003 NHIS data among persons 65 years of age and older were 69 percent among non-Hispanic whites, 48 percent among non-Hispanic blacks, and 45 percent among Hispanics.

Several studies have shown standing orders are one of the most effective ways to increase flu vaccination rates. Consequently, the ACIP recommends the use of standing orders in both outpatient and inpatient settings. Standing orders remove the physician signature requirement from the Conditions of Participation for Medicare and Medicaid participating entities including home health agencies (HHAs). HHAs can also help to increase flu vaccination rates by encouraging patients to receive a flu shot annually at physician offices, clinics, or in their homes.

Pneumococcal vaccine

Pneumococcal polysaccharide vaccine (PPV) may be administered at the same time as the flu vaccine. Those who should receive the vaccine are the following:

• All adults 65 years of age or older
• Anyone over 2 years of age who has a long-term health problem such as:
• Heart disease
• Lung disease
• Sickle cell disease
• Diabetes
• Alcoholism
• Cirrhosis
• Leaks of cerebrospinal fluid
• Anyone over 2 years of age who has a disease or condition that lowers the body’s resistance to infection such as:
• Hodgkin’s disease
• Lymphoma, leukemia
• Kidney failure
• Multiple myeloma
• Nephrotic syndrome
• HIV infection or AIDS
• Damaged spleen or no spleen
• Organ transplant
• Anyone over 2 years of age who is taking any drug or treatment that lowers the body’s resistance to infection such as:
• Long-term steroids
• Certain cancer drugs
• Radiation therapy
• Alaskan Natives and certain Native American populations

Typically, for those 65 years of age and older, PPV need only be administered one time. A second dose is recommended for those people 65 years of age and older who received their first dose when they were under 65, if 5 or more years have passed since that dose. Also, vaccination is recommended for those 65 years of age and older when the vaccination history is unknown.

As in the case with flu vaccination, HCWs can play an important role in increasing PPV vaccination rates. Dr. Zimmerman notes that the following are predictors of ever receiving PPV:

• Recommendation from their doctor’s office to receive the shot
• Belief that their doctor thinks they should get the shot
• Feeling that getting the pneumonia shot is a wise thing to do
• Receipt of the influenza vaccine in the most recent flu season

Dr. Zimmerman also reports the following are the most common explanations for not receiving a PPV vaccination:

• The patient’s doctor did not recommend a pneumonia shot
• The patient did not know he or she needed the shot
• The patient did not think it likely he or she would get pneumonia

Both flu vaccine and PPV have an excellent safety profile. Typically reactions are mild, such as redness or pain where the shot is given. HCWs should emphasize to patients that getting flu or pneumonia is far more likely to cause serious problems than those arising from getting either or both vaccines.

Survey Reveals Pattern of Agencies’ Immunization Practices

By Linda Day, RN, BSN, MBA, Quality Improvement Project Supervisor

Pneumococcal disease, Streptococcus pneumoniae, and influenza together are the fifth leading cause of death in the United States among persons aged 65 years or older. Immunization rates have improved dramatically in the last 15 years, yet infection rates among these vaccine-preventable diseases are still staggering: Each year, influenza infects 5 to 20 percent of the U.S. population and causes more than 200,000 hospitalizations and an average of 36,000 deaths. Likewise, there are an estimated 125,000 hospitalizations caused by pneumococcal pneumonia each year, with a case-fatality rate of 5 to 7 percent, but higher in the elderly.

In Ohio, we have seen a 13.3 percent decline in vaccination rates, from 51.6 percent in 2003 to 38.3 percent in 2004.

Last October, Ohio KePRO mailed the Immunization Survey for Ohio Home Health Agencies to HHAs throughout the state. Of the 155 agencies that responded, 113 (72.9 percent) assess for influenza immunization and 111 (71.6 percent) assess for pneumococcal immunization. This indicates that an HHA that includes assessments of home health patients’ immunization history and the need for vaccination as part of the agency’s comprehensive patient assessments usually screens for both influenza and pneumococcal immunization.

In the coming months, Ohio KePRO will use information collected from the survey to design appropriate interventions that help HHAs consistently screen patients at SOC/ROC and either administer immunizations as needed or refer patients to community resources.

Immunization Resources CD

Ohio KePRO will soon make available a free Immunization Resources CD to all Home Health Agencies in Ohio. For further information or to order the CD, please contact the Home Health Team at 1-800-385-5080; e-mail: homehealth@ohqio.sdps.org.

In addition, the following Web sites provide useful immunization information:

www.cdc.gov/flu

The official influenza Web site for the Centers for Disease Control and Prevention (CDC).

www.cdc.gov/flu/gallery

CDC's Flu Gallery is now open for the flu season. This Web site has numerous resources including: posters, flyers, Q & As related to vaccination production and supply, prioritizing recommendations, fact sheets in several languages, etc.

www.cdc.gov/mmwr/

The Web site for the CDC’s Morbidity & Mortality Weekly Report (MMWR). The data in the weekly MMWR are provisional, based on weekly reports to the CDC by state health departments.

www.immunize.org/

A non-profit organization that works to increase the immunization rates and prevent disease by creating and distributing educational materials for health professionals and the public that enhance the delivery of safe and effective immunization services. The Coalition also facilitates communication about the safety, efficacy, and use of vaccines within the broad immunization community of patients, parents, health care organizations, and government health agencies.

www.medqic.org

The Centers for Medicare & Medicaid Services (CMS) developed this comprehensive online resource of quality improvement information for Medicare's National Quality Improvement Priority Topics. The Immunization Toolkit 2006 has been updated with new information on influenza and pneumococcal vaccinations. The Toolkit is full of valuable sample policies, forms, educational materials, references, and more. New to this Toolkit are sections related to avian and pandemic influenza.

Set Goals for Improvement on New Web site for Home Health Agencies

A new Web site – www.hhqi-star.org –allows home health agencies to set goals for improvement for the following publicly reported quality measures:

• Acute Care Hospitalization
• Emergent Care
• Discharge to Community
• Improvement in Ambulation
• Improvement in Bathing
• Improvement in Dyspnea
• Improvement in Management of Oral Medications
• Improvement in Pain Interfering with Movement
• Improvement in Status of Surgical Wounds
• Improvement in Transferring
• Improvement in Urinary Incontinence

Registration on this site is free and available to all Medicare and/or Medicaid certified home health agencies. To get your agency’s password and gain access to this Web site, contact Ohio KePRO’s Home Health Team at 1.800.385.5080 or send e-mail to homehealth@ohqio.sdps.org

The Quality of Health Care Explored in Four-Part PBS Series: Remaking American Medicine™…Health Care for the 21st Century

Remaking American Medicine™…Health Care for the 21st Century explores the quality crisis and the innovative solutions being undertaken by providers, patients and their families to transform the care provided by the institutions upon which we all depend. The four one-hour programs are scheduled to air on PBS on consecutive Thursdays on October 5, 12, 19 and 26 at 10 p.m.

Each program examines critical health care issues facing Americans today including patient safety, medical and medication errors, hospital-acquired infections, family-centered care and effective management of chronic disease. But rather than assign blame for the failings in health care, series producer Crosskeys Media® offers solutions by showcasing the stories of individuals and institutions who are working to ensure better health care for everyone.

Emotionally engaging profiles

“We wanted to present detailed and emotionally engaging profiles of people like Dr. Donald Berwick, founder of the Institute for Healthcare Improvement, who are struggling to fix our broken health care system,” said Frank Christopher, executive producer, Crosskeys Media. “Remaking American Medicine is their story, told through the eyes of doctors, nurses, administrators and patients, showing their struggles, their setbacks and their victories. We call these people and their institutions Champions of Change.” “Patient safety is at the vanguard of Remaking American Medicine and transformational change,” said Alice Stollenwerk Petrulis, MD, FACP, Chief Medical Officer for Ohio KePRO and its parent organization, KePRO, Inc. “The compelling nature of this unprecedented series will help advance a patient-centered culture of ensuring care that is safe, effective, efficient, timely, and equitable.”Additional information is available by visiting www.RAMcampaign.org.

MOA Reminder

Earlier this year, Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio, mailed to your home health agency (HHA) a Memorandum of Agreement (MOA). In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO.

MOAs outline the QIO’s and provider’s responsibilities during the review process. MOAs are also intended to be informational.

Section 1866 (a)(1)(E) of the Social Security Act requires providers of services to have an agreement with a QIO to release data related to patients. Section 1866 (a)(1)(F)(ii) of the Social Security Act requires hospitals, critical access hospitals, skilled nursing facilities, hospices, LTACs, CORFs and home health agencies to maintain an agreement with a QIO to perform certain functions. The MOA describes (a) Ohio KePRO procedures with respect to certain contract obligations, (b) review and appeal rights providers have with respect to these obligations, and (c) opportunities providers have to partner with Ohio KePRO in local and national quality improvement projects.

If your HHA has not returned the MOA, please do so today. Should you need a replacement copy or have any questions, please contact Linda Greel at 216-654-1541. Thank you.

Save the Dates!!!

Regional Seminar and Learning Session III schedule:

October 24, 2006

Mount Carmel Home Care

Columbus, Ohio

October 26, 2006

Bridge Home Health and Hospice

Findlay, Ohio

October 31, 2006

Kettering Network Home Care

Miamisburg, Ohio

November 1, 2006

Wadsworth-Rittman Hospital Home Care

Wadsworth, Ohio

Sessions are open to all agencies. For more information, please call the Home Health Team at 1-800-385-5080 or e-mail homehealth@ohqio.sdps.org. Also, check forthcoming issues of the Home Health Tip of the Week for details.

Order Free Materials

Ohio KePRO offers a variety of free CD-ROMs, brochures, booklets, and clinical pocket guides to help your home health agency provide quality care to patients. View Shopping Bag>>

We encourage you to share the newsletter with others at your facility or practice. Those who wish to receive their own issues of Quality Outcomes can subscribe free of charge to the newsletter by visiting www.ohiokepro.com >Publications >Newsletters >Subscribe Online.

Ohio KePRO Home Health Team

Betty Pilous, RN, MHSA, CPHQ

Linda Day, RN, BSN, MBA

Eileen Wallenhorst, RN, BSPA

Carolynn Guelker, RN, CCM

Tracy Hammer, LPN

Rosalie McGinnis, RN, MS

Robin Reitzel, BS

Miriam Rose, MEd

Donna Maynard

Chris Titus, MCSE, CNA, MCP

 

Editor: Robert A. Feigenbaum, MS

 

 

 

 

 

To Contact Us
E-Mail: homehealth@ohqio.sdps.org
Provider QIC Line: 1.800.385.5080

 

Rock Run Center, Suite 100 · 5700 Lombardo Center Drive · Seven Hills, OH 44131 · www.ohiokepro.com

 

Ohio KePRO, the Medicare Quality Improvement Organization (QIO) for Ohio, is working with committed hospitals, nursing homes, home health agencies, and physicians throughout the state who are dedicated to the common goal of Continuous Quality Improvement for Medicare beneficiaries.