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1 Thank You for Joining! Learning Series: Immunizations New England Nursing Home Quality Care Collaborative Webinar Will Begin Shortly. Call-In Number: (888) Access Code: This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), the Medicare Quality Improvement Organization for New 9/6/2016 England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSQI_C2_201609_0692 1

2 Thank you for being part of the New England Nursing Home Collaborative How we can support you Technical Support (QAPI) Organized Affinity Groups (Learning & Sharing) LTC Stakeholder Collaboration Virtual Educational Webinars/Materials/SME Quarterly Data Reports to Track Progress 9/6/2016 HealthCareForNewEngland.org/providers/nursing-home 2

3 View & Download our Educational Modules at: HealthCareForNewEngland.org/providers/nursing-home/#edu HealthCareForNewEngland.org/providers/nursing-home 3

4 Shot from the Heart: Everyone s Role in Protecting Residents by Ensuring Immunizations Stefan Gravenstein, MD, MPH, CMD Professor of Medicine Clinical Director, Healthcentric Advisors Director, Center for Geriatrics and Palliative Care University Hospitals and Case Western Reserve University Adjunct Professor of Medicine, Brown University Russ Cooney, B.A. Program Coordinator, Healthcentric Advisors 4

5 Today s Objectives: Participants will be able to Describe current trends in adult vaccination Reduce flu & pneumonia in your facility Identify appropriate people for vaccination Improve documentation & tracking of residents & staff 03/24/15 HealthCareForNewEngland.org/providers/nursing-home 5

6 Stefan Gravenstein, MD, MPH, CMD Professor of Medicine Clinical Director, Healthcentric Advisors Director, Center for Geriatrics and Palliative Care University Hospitals and Case Western Reserve University Adjunct Professor of Medicine, Brown University 6

7 Objectives HealthyPeople 2020 Goals and Progress Know who should be vaccinated New guidelines on PPSV23 and PCV13 How to reduce the incidence of influenza and pneumonia in your facility Including residents, staff and family members in your efforts to reduce vaccine preventable illnesses Improving documentation and tracking of immunizations for both long and short term residents Effective tracking of staff immunizations 7

8 Much of Pneumonia and Influenza are Vaccine-preventable Accessed 30 Aug

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10 Nursing Home Residents are the Group at Greatest Risk For P&I 10

11 HealthyPeople 2020: Goals on Immunization Pneumococcal disease Vaccination coverage Baseline coverage of 60% in 2008 Goal coverage of 90% in 2020 Invasive disease Baseline rate 40.7 new invasive cases per 100,000 adults over age 65 (2008) Target rate 30.5 new cases per 100,000 adults over Antibiotic resistant disease Baseline rate 12.2 new antibiotic resistant cases per 100,000 adults over age 65 (2008) Target rate 9.0 new cases/100,000 adults over age 65 Influenza Vaccination coverage Current coverage ~80% nursing home residents; 55-65% nursing home healthcare workers Goal coverage 90% residents, 90% staff 11

12 HealthyPeople 2020: Goals and Progress for Influenza Vaccination Population 1998 * (%) (%) 2010 Goal (%) Adults aged 65 years High-risk adults years old HCW: ALL LTC Office Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2009; 58(39); and 2, 2010; 59(12); U.S. Department of Health and Human Services. Healthy People nd ed. Washington, DC: U.S. Government Printing Office, November *Source = National Health Interview Survey (NHIS), CDC. 12

13 Influenza Vaccine Healthcare Worker Coverage Nursing home health care workers HealthyPeople 2020 goal 90% 52.4% overall 79.2% with employer vaccination policy 41.3% without vaccination policy Factors improving healthcare worker vaccine uptake Employer vaccination policy Employer promotion Free vaccine available for more than just one day Knowledge and attitudes Most common error in vaccine knowledge: I can get influenza from the vaccine. Accessed 28 Aug

14 Mechanism How is Influenza Spread? Small droplets Coughing, sneezing Talking Possibly inanimate objects by direct contact (fomites) By whom Primarily staff and visitors, including family members 14

15 They can unwittingly transmit flu to others, even when still feeling relatively well; 10-50% get it each year, half never knew it Vaccination reduces sick time and protects them from getting flu from children (70% effective) Vaccine reduces the likelihood of hospitalization from a heart attack, stroke or pneumonia each by 8-30% People Don t Know Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2009; 58(39); Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2010; 59(12); Nichol KL, et al. N Engl J Med. 2003;348:

16 Increasing Vaccine Uptake Greater vaccine uptake for patients in general, and reduced disparity in vaccine uptake when: There are standing orders for vaccination Verbal consent for vaccine is allowed Seasonal vaccination campaigns are included Uptake among the health care staff is high Access and payment System tracking of who has been vaccinated, EMR triggers Education Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. 2009; 58(39); Bardenheier B, et al. Academy Health June

17 Common Myths Vaccine contains unsafe preservative NO the preservatives are safe, and single dose (pre-filled syringes) are preservative-free I get flu from the shot NO, NO, NO! I can wait until flu is here to get my shot It s enough if I am vaccinated, I don t need my family to get it, too 17

18 Influenza Take-homes Get standing orders for residents and for any nurse to give it to other healthcare workers Consider adding an approach that allows and promotes family members to get influenza vaccine at your facility Consider which of the various vaccines available are right for your residents, their families and your staff High Dose and Adjuvanted, trivalent, quadrivalent; intramuscular vs intradermal vs intranasal 18

19 Pneumococcal Disease Invasive pneumococcal disease has been on the decline in the last two decades, largely because of vaccine 19

20 accessed 28 Aug

21 Pneumococcal Vaccine Uptake and HP2020 Goal accessed 28 Aug 16 21

22 Pneumococcal Vaccines Two products PCV13 and PPSV23 ACIP recs are not without controversy Complex regimen Multi-shots and long interval Often records not perfect on what someone has received in the past Some data but not a robust amount of data yet We have a lot of herd immunity in the US to S. pneumo so this may mitigate benefit somewhat 22

23 Pneumococcal Vaccines Brand Name Pharmaceutical Company PCV13 Prevnar 13 Pfizer PPSV23 PNEUMOVAX 23 Merck 23

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26 To Get Key Schedules For Vaccines General vaccine tables Search CDC adult vaccines Pneumococcal vaccine information Search Pneumococcal Vaccine Timing for Adults 26

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29 HealthyPeople 2020 Summary Everyone should get the influenza vaccine, even family members Everyone over the age of 65 should get a pneumococcal vaccine Goal is that all eventually will have gotten both: PCV13 AND PPSV-23 Getting vaccine protects people who get it and potentially those around them Standing orders, education, health professionals setting the example Tools you can use 29

30 Russ Cooney, B.A., Program Coordinator, Rhode Island 30

31 Resident Immunizations: Resident Tracking January 2016 Resident Name Unit Admission Date Date Date PPD #1 PPD #2 Flu PCV13 PPSV23 Date Given Given Given D/C Date Comments Mouse, Mickey 5 1/2/ /4/2016 Montoya, Inigo 3 1/4/ /27/2016 Anthony, Susan B 2 1/5/ n/a PPSV23 due 10/16 Obama, Barack 6 1/7/ /28/2016 Missed opportunity/flu Total # Given Total Total Patients - Jan % of Total 100% 100% 75% 100% 100% 95% Vax Key 1 Vax Given 0 Offered and declined n/a Exception/Not Due Missed Opportunity

32 Data Flu Vax Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec % 71.4% 67.7% 83.9% 75.0% 75.0% 77.8% 84.6% #DIV/0! #DIV/0! #DIV/0! #DIV/0! % 54.5% 55.6% 56.3% 61.1% 38.5% 44.4% 50.0% 28.6% 42.9% 69.2% 76.0% RI Ave 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% 83.5% Nat'l Ave 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% 80.3% PCV 13 (Prevnar 13) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec % 45.8% 50.0% 66.7% 82.4% 57.1% 57.1% 84.2% #DIV/0! #DIV/0! #DIV/0! #DIV/0! % 55.6% 66.7% 64.3% 64.3% 33.3% 34.5% 53.6% 42.9% 36.4% 42.9% 20.0% RI Ave 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% Nat'l Ave 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% PPSV23 (Pneumovax) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec % 57.1% 45.5% 82.6% 71.4% 58.3% 72.7% 71.4% #DIV/0! #DIV/0! #DIV/0! #DIV/0! % 47.1% 60.0% 57.1% 60.0% 14.0% 17.2% 30.0% 13.9% 31.4% 42.9% 20.0% RI Ave 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% 81.2% Nat'l Ave 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1% 81.1%

33 Graphs

34 Staff Immunizations Staff Name ID # Flu Shot Given Date January 2016 Flu Shot Declined Date Declination form completed Documentation Provided (for exceptions or external immunization) Informed of mask requirements during widespread flu Brady, Thomas /1/2015 Goodell, Roger /3/2015 Yes Yes Yes Gronkowski, Rob /12/2015 Yes Comments Totals 2 1 Percentage 66% 33%

35 Questions about the Spreadsheet? Put any questions in chat and we ll address these on our follow-up webinar on September 29 th 35

36 Contact your Nursing Home Quality Improvement State Lead Connecticut Florence Johnson: Maine Danielle Watford Massachusetts Sarah Dereniuk: New Hampshire Pamela Heckman: Rhode Island Nelia Silva Odom: Vermont Gail Harbour: 36