INFECTION CONTROL NEWSLETTER

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)656-7887 Voice/FAX
jmarx@concentric.net 

• Include vaccination orders in the physician's orders. Establish admission orders to vaccine all new admissions for influenza. Include vaccination for all current residents during the month of October
• Promote influenza and pneumococcal vaccines. Include paycheck stuffers, bulletin board notices.
• The one-time pneumococcal vaccine can be given at any time during the year.
• Designate staff to sustain vaccination systems. Include vaccination activities as part of the CQI process. Provide staff inservice education on the benefits of vaccination and dispel the myths.
• Establish a vaccination goal, such as >90% of the residents and >80% of the staff will be vaccinated by December 1, 1999.
• Talk to family and residents about the benefits of vaccination. Speak at the Resident and Family Council about the importance of vaccination.

The following hints about the administration of the influenza vaccine will help you from wasting valuable staff time.

• You have the option of either a physician's order OR the resident/family consent. If you use vaccine provided by the State of California, this is clearly stated on the Agreement letter you get when you apply for vaccine. Check with your local immunization program for more details.
• Use FREE promotional materials. Call California Medical Review, Inc. for information 877-363-5555.
• Limit post-vaccination vital signs to 6 hours after the vaccine is given. Read the vaccine insert which states that adverse reactions will occur with 6 hours of vaccine administration. Taking vital signs after that period increases work for the staff. In addition, a fever after that period may indicate a true infection, such as urosepsis or pneumonia.

• Influenza and Pneumococal vaccine can be given at the same time. They must be given at different sites.

• Most common side effects last 1-2 days and are: soreness, redness or swelling at the injection site; fever; aches.

• The vaccine is protective 1-2 weeks after administration and lasts up to one year.
• The U.S. influenza season lasts from December to April.

 The newly introduced Quality Indicators were developed by CHSRA, the Center for Health Systems Research and Analysis, University of Wisconsin, 610 Walnut Street, Madison, WI 53705, 608-263-5722 (voice), 608-263-4523 (fax).

They can be found on the Internet at http://www.chsra.wisc.edu/CHSRA/QIs/QIs.htm

The Quality Indicators (QI) will be used by the survey team to identify potential problem areas in your facility. They are based on the data your facility submits electronically thought the MDS resident assessment tool. It is critcal to review this infomrtaion on a regular basis to insure accuracy of data.

The 24 indicators will compare your facility's performance against that of all other facilities that submit MDS information in your State. CAUTION: Your facility has a unique set of resdients, and the comparison group may not reflect your type of resident population. Be sure to look at the facility characteristics page to see in what ways your facility differs from the State's comparison group. Currently, there is no method to correct for the inconsistances in the population at risk.

The QI will be based on quarterly MDS submissions only (including annual MDS assessments). It will exculde admission and re-admission MDS infomration. It will be important to insure that the MDS coordinator has accurate information on the assessment form.

The following examples are potental problem areas:
 

Indicator 2
Definition of fall
Not specificed in MDS 2.0 manual
Needs to be clarified

Indicator 6
Definition of medication
Count the number of different medications (not doses or different doses) administered by any route at any time during the past seven days. Includes routine, prn and stat doses. Includes topical preparations, ointments, creams used in wound care, eyedrops, vitamins and suppositories. Includes self administered meds.

Indicator 9
Definition of toileting plan
A plan whereby the staff members at scheduled times each day either take the resident to the toilet room, or give the resident a urinal or remind the resident to go to the toilet. Includes habit training and prompted voiding.

Indicator 11
Definition of fecal impaction
The presence of hard stool upon digital rectal exam. Fecal impaction may also be present if stool is seen on abdominal x-ray in sigmoid colon or higher, even with a negative digital exam or documentation in the clinical record of daily bowel movement.

Indicator 12
Definition of urinary tract infection
Includes chronic and acute symptomatic infection(s) in the last 30 days. Check this item only if there is current supporting documentation and significant laboratory findings in the clinical record.

Indicator 15
Defintion of dehydration
The resident must have 2 or more of the following: - resident usually takes in less than the recommended 2500 ml of fluids daily (water or liquids in beverages, and water in food) - resident has clinical signs of dehydration -residentÕs fluid loss exceeds the amount of fluids he or she takes in (e.g., loss from vomiting, fever, diarrhea that exceeds fluid replacement)

Indicator 16
Definition of Bedfast Resident
Resident is in bed or in a recliner in own room for 22 hours or more per day. Includes residents who are primarily bedfast but have bathroom privileges. (4 days in the past 7 days)

Indicator 23
Defintion of Little or No Activity
Average time involved in activities is less than 1/3 (when awake and not receiving treatments or ADL care) Activities listed on the Full MDS are: Cards/other games. Crafts/arts, exercise/sports. music, reading/writing. spiritual/religious activities, trips/shopping, walking, wheeling outdoors, watching TV, gardening or plants, talking/conversation, helping others