Study reveals that majority of all vaccine preventable deaths occur in those 65 and older

The Patient Safety Authority Encourages Older Persons and Healthcare Workers to Get Immunized and Offers New Consumer Tips Based Upon Authority Data

Ninety percent of all vaccine preventable deaths occur in those 65 and older, including residents in nursing homes, according to highlighted studies in the Pennsylvania Patient Safety Authority's 2009 December Patient Safety Advisory.

According to the Centers for Disease Control and Prevention (CDC) and the Advisory Committee for Immunization Practices (ACIP), vaccination remains the best approach to protect older persons with chronic health conditions who are considered at high risk for exposure to influenza, invasive pneumococcal disease (e.g., pneumonia, bacteremia, meningitis) and complications.

However, on average, only 42 percent to 66 percent of long-term care residents received these vaccinations, according to a recent National Center for Health Statistics report. Pennsylvania nursing homes rank 38th for residents given the flu shot and 26th for residents given the pneumonia shot, more than three percent below the national average for both shots.

Healthcare workers self-report a low 45 percent participation in getting flu shots, and unvaccinated healthcare workers risk spreading the flu to their long-term care residents and patients. In its Healthy People 2010 goals, the CDC recommends 90 percent vaccination rate for institutionalized adults with high-risk conditions that may contribute to unnecessary outbreaks of flu and pneumonia within long-term care facilities and hospitals.

"The Authority's research shows patients and healthcare workers are not getting immunized when studies show immunizations can prevent flu and pneumonia which causes ninety percent of vaccine preventable deaths in persons sixty-five and older," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Long-term care and healthcare facilities need to take another look at their annual immunization programs to ensure staff, residents and patients are getting vaccinated.

"Educational efforts also need to be stepped up to ensure staff, residents and patients understand the benefits and consequences of getting the shots as opposed to not getting the shots," Doering added.

Studies show that many healthcare workers may not be up-to-date with current recommendations regarding the flu and pneumonia vaccination. Historically, ACIP has recommended the flu vaccine should be offered beyond the traditional fall immunization season (October into January and beyond). However, this recommendation has changed. The vaccination should be given as soon as it is available until the end of flu season (April/May) depending on activity.

A 2000 national survey of 1,606 physician practices shows 43 percent of respondents stopped vaccinating in December and only 27 percent vaccinated into February. Also, a direct personal recommendation from healthcare providers has been shown to increase immunization rates among residents who are opposed to vaccination.

"While education alone does not significantly affect vaccination rates, medical and support staffs that are more current in their knowledge are more likely to get the shots themselves and be more persuasive to residents who are unsure about getting vaccinated," Doering said.

Nursing homes may also not be aware that in October 2002, the Centers for Medicare and Medicaid Services (CMS) published a final rule removing the physician signature requirement for flu and pneumonia vaccinations. Written consent from the patient is also not required before giving vaccines, according to the Pennsylvania Medical Care and Reduction of Error (MCARE) Act of 2002. The only informed consent required is information given to the patient about the pros and cons of receiving the flu or pneumonia shot.

"Healthcare workers err on the side of caution in requiring these signatures, but it really is hindering the distribution of the vaccines unnecessarily," Doering added.

The Authority highlighted some nursing home facilities in Pennsylvania that have implemented vaccination programs with more than 90 percent success rates. They include: Gwynedd Square Center for Nursing, Lansdale, PA; Tel Hai Retirement Community, Honey Brook, PA; and Davis Manor, Mountaintop, PA.

For more information about the successful vaccination programs or the studies about vaccinations, go to the 2009 December Pennsylvania Patient Safety Advisory article "Increasing Influenza and Pneumonia Vaccination Rates in Long-Term Care" at the Authority's web site www.patientsafetyauthority.org. Vaccination consumer tips are also available at the same web site. Consumers can also go the Pennsylvania Department of Health's web site at www.health.state.pa.us for locations to receive the flu shot by zip code, click on "Focus on Flu."

The Authority's quarterly December Advisory contains other articles developed from data submitted about real events that have occurred in Pennsylvania's healthcare facilities. The articles also provide advice and prevention strategies for facilities to implement within their own institutions. An article with consumer tips is noted with an asterisk (*). Highlights include:

• Neuromuscular Blocking Agents (NMBA): Reducing Associated Wrong Drug Errors: NMBAs are medications commonly used to paralyze patients during surgery that is conducted under general anesthesia and for patients that must receive a breathing tube. These medications are used in emergency departments, intensive care units, some radiology areas and medical and surgical units. These drugs make patients unable to move or breathe and are considered high-alert medications because misuse can lead to catastrophic injuries and even death. The Authority has received 154 reports of medication errors involving NMBAs. Analysis shows 37 percent were wrong-drug errors and 16 percent were wrong-dose/overdosage errors. Further analysis shows that in 47 percent of the cases the drug given should not have been an NMBA at all. The Authority has provided strategies for facilities to address these problems.
• *Inadequate Screenings for Patients At-Risk of Choking Can Cause Patient Deaths: Pennsylvania healthcare facilities submitted 133 event reports of patients having problems swallowing or choking that were not due to anesthesia. Seventy-three of the reports (55%) showed that screenings had been done for the patient to determine whether or not they had trouble swallowing, which may mean the screenings are not adequate. The other 60 reports (45%) show patients had not received a screening at all to determine whether or not they had swallowing problems and/or were at risk for choking. The Authority discusses the problem and provides strategies for improving screening tools. Consumer tips are also available for this article to encourage families to check with healthcare providers before giving their loved ones anything to eat that may cause them to choke.
• Monitoring Patient Safety in Hospitals Through Administration Data: The Authority, along with other healthcare organizations and agencies, are asked often whether or not patient safety has improved since the 1999 publication of the Institute of Medicine's "To Err is Human" report that stated more than 98,000 patients die each year due to preventable medical errors. This article discusses how using data known as patient safety indicators, which are based upon hospital discharge data, can provide an independent source of patient safety information.
• Taking a Look at Safe Patient Handling and Movement Programs in Rehabilitation Settings: Handling or moving patients can be a high-risk occurrence within a facility that can cause harm to both healthcare workers and the patient. This article discusses the issue in depth and provides facilities with strategies for implementing a no-lift or minimal-lift policy.
• Wrong-Site Surgery Quarterly Update: The Authority continues to see encouraging signs that wrong-site surgery is decreasing in Pennsylvania. The 2009 third quarter total was the second lowest quarterly total ever. The third quarter of the year is usually the quarter when the resident training cycle traditionally begins and thus more errors are likely to occur. The trend toward fewer reports of wrong-site surgery reinforces the Authority's belief that the advice developed from its Preventing Wrong-Site Surgery Project is useful.

For a copy of the 2009 December Pennsylvania Patient Safety Advisory or more information on the Pennsylvania Patient Safety Authority, visit the Authority's web site at www.patientsafetyauthority.org.