Vaccinations Protect Residents and Staff, also Affect Nursing Home Composite Scores

Influenza Vaccinations

Around 3,500 people die of the flu each year across the nation. An institutional Influenza A outbreak can result in up to 60 percent of the population becoming ill, with 25 percent of those affected developing complications severe enough to result in hospitalization or death. Influenza vaccinations must be provided routinely to all residents and healthcare workers of long-term care facilities.

  1. If possible, all residents should receive trivalent inactivated influenza vaccine (TIV) annually before the influenza season. In the majority of seasons, TIV will become available to long-term care facilities. beginning in September, and influenza vaccinations should be given as soon as vaccine is available.
  2. Healthcare personnel who get vaccinated help to reduce transmission, staff illness and absenteeism and flu-related illness and death, especially among people at increased risk.

Pneumococcal Vaccinations

Pneumonia is the leading cause of morbidity and mortality for patients in long-term care, and pneumococcal vaccinations are an effective preventive measure. In this population, recognition may be delayed because pneumonia often presents without fever, cough, or dyspnea.

Know The Measurement Periods

It is important to note that the influenza vaccination measures are calculated only once per 12-month influenza season, which is July 1 of a given year and ends on June 30 of the subsequent year. For these measures, the target period begins on October 1 and ends on March 31. This means the end-of-episode data will be March 31 for an episode that is ongoing at the end of the influenza season and that March 31 should be used as the end date when computing classifying stays as long or short for the influenza vaccinations measures. Quality Measures cannot be changed after March 31.  There are often questions around revaccination. Please note, the algorithm above is for pneumococcal vaccine administration only.

A few helpful tips to monitor and track flu and pneumonia vaccinations include the following:

  1. Document the immunizations given at your facility and outside your facility, such as from the local pharmacy and physician offices.
  2. Call the Medicare-provided insurance to verify, if necessary.
  3. Update the MDS assessment with the vaccination information each quarter.

Review your in-house report to identify accuracy.  This information will not be on the CASPER Facility Level report.

MDS Coding

Now is an opportune time to discuss and review the coding of item O0250 (Influenza Vaccine) and O0300 (Pneumococcal Vaccine). Again, update the MDS assessment with the vaccination information each quarter.  Your nursing home does not have to administer the vaccines to get credit, as long as the vaccines are given within the timeframe (received in the current flu season or the past five years for pneumococcal). Details for MDS coding may be found in the MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual Version 1.15 (October 2017).

Coding Tips and Special Populations


  • Once the influenza vaccination has been administered to a resident for the current influenza season, this value is carried forward until the new influenza season begins.
  • Residents should be immunized as soon as the vaccine becomes available and continue until influenza is no longer circulating in your geographic area.
  • The annual supply of inactivated influenza vaccine and the timing of its distribution cannot be guaranteed in any year. Therefore, in the event that a declared influenza vaccine shortage occurs in your geographical area, residents should still be vaccinated once the facility receives the influenza vaccine.
  • A “high dose” inactivated influenza vaccine is available for people 65 years of age and older. Consult with the resident’s primary care physician (or nurse practitioner) to determine if this high dose is appropriate for the resident.
  • The CDC has evaluated inactivated influenza vaccine co-administration with the pneumococcal vaccine systematically among adults. It is safe to give these two vaccinations simultaneously. If the influenza vaccine and pneumococcal vaccine will be given to the resident at the same time, they should be administered at different sites (CDC, 2009). If the resident has had both upper extremities amputated or intramuscular injections are contraindicated in the upper extremities, administer the vaccine(s) according to clinical standards of care.


  • “Up to date” in item O0300A means in accordance with current Advisory Committee on Immunization Practices (ACIP) recommendations.
  • If a resident has received one pneumococcal vaccination and it has been less than one year since the resident received the vaccination, he/she is not yet eligible for the second pneumococcal vaccination; therefore, O0300A is coded 1, yes, indicating the resident’s pneumococcal vaccination is up to date.

As your nursing home enters the 2018-2019 flu season, we have a free resource library for adult immunizations that provides tools and resources for caregivers to help improve immunization rates and quality of life. Also, the Centers for Disease Control and Prevention (CDC) has excellent resources for education and promotion of immunizations. There are materials available for free download and select materials available to order.