Failure to Provide Updated Pneumococcal Vaccine Education and Offer New Vaccines
Penalty
Summary
The facility failed to provide the most recent Centers for Disease Control (CDC) education regarding the risks and benefits of vaccinations and did not offer the most recent pneumococcal vaccines to three out of five residents reviewed for immunizations. Specifically, the medical records for these residents did not document whether they received the Vaccine Information Statements (VIS) or education about the risks and benefits of the pneumococcal vaccine. Additionally, there was no documentation indicating that these residents were offered or had accepted or declined the newer pneumococcal vaccines (PCV20 or PCV21), despite having received earlier versions of the vaccine in previous years. Interviews with nursing staff and the Director of Nursing revealed that while vaccination status is reviewed upon admission and annually during care conferences, there was no established process to re-evaluate current residents' pneumococcal vaccination status outside of these times. The facility's standing orders and policies referenced the use of older pneumococcal vaccines and did not address the newer recommendations. As a result, the facility did not ensure that current residents were consistently offered the most up-to-date pneumococcal vaccines or provided with the latest CDC educational materials as required.