Failure to Offer Updated Pneumococcal Vaccination per Policy and CDC Guidelines
Penalty
Summary
The facility failed to offer the updated Pneumococcal Conjugate Vaccine (PCV20) to two residents, despite both the facility's policy and current CDC recommendations requiring assessment and offering of the vaccine. According to the facility's policy, residents are to be assessed for pneumococcal vaccination status upon or prior to admission, and the appropriate vaccine series should be offered within thirty days unless contraindicated or already completed. Documentation review revealed that one resident had previously received PCV13 in 2016 and PPSV23 in 2018, while another had received PCV13 in 2018 and refused PPSV23 in 2022. In both cases, there was no evidence in the clinical records that PCV20 was offered, administered, or refused. During an interview, the Administrative Coordinator stated that PCV20 was not offered to these residents because she believed that receipt of PCV13 meant the residents were up to date with pneumococcal vaccinations. This belief was contrary to both CDC recommendations and the facility's own policy, which require consideration of PCV20 administration based on the timing and type of previous pneumococcal vaccines. The surveyor confirmed that the required vaccine was not offered as indicated by policy and CDC guidelines.