Failure to Offer and Document Required Vaccinations
Penalty
Summary
The facility failed to ensure that recommended influenza, pneumococcal, and Covid-19 vaccinations were offered and/or provided in a timely manner, as outlined by CDC guidelines, for one of five residents reviewed for immunizations. Review of the electronic medical record (EMR) for this resident showed no evidence that the resident was educated about, offered, or received or declined the influenza, pneumococcal, and Covid-19 vaccines. During an interview, the infection control preventionist confirmed that the facility's expectation is to offer and document vaccine status for all residents, including documentation of education, what was offered, and whether the vaccine was received or declined. The infection control preventionist also verified that the EMR lacked documentation of refusals and follow-up for the resident's vaccine status. The facility's policy requires that all residents and their legal representatives be offered these vaccines and that the EMR reflect education provided, receipt, or refusal, but this was not followed in the case reviewed.