Influenza and Pneumococcal Immunization Standing Orders
PDF Version of BQA 02-019
(PDF, 11 KB)
Date: October 14, 2002 -- BQA Memo 02-019
FROM: Janet Eakins, Section Chief, PRQI, Bureau of Quality
via: Susan Schroeder, Director, Bureau of Quality Assurance
The U.S. Department of Health and Human Services recently announced a
new policy to promote greater access to flu and pneumonia vaccinations,
especially among older Americans and others at high risk for illness. This
change is included in new Medicare regulations that modify the conditions
of participation for hospitals, long-term care facilities and home health
agencies that serve Medicare and Medicaid beneficiaries. Please see the
press release (exit DHS) and CMS
memorandum S&C-03-02 (exit DHS; PDF).
The Bureau of Quality Assurance authorizes the use of standing order
programs to increase the rates of influenza and pneumococcal immunizations
in vulnerable people in Wisconsin. The requirement for specific written
physician orders in the provisions listed below is waived with respect to
influenza and pneumococcal polysaccharide immunizations. The waiver is
conditioned by administration of the immunizations in accordance with a
physician-approved policy for the facility or agency and after an
assessment for contraindications.
HFS 132.60 (5) Treatment and Orders. (a) Orders. 1. ‘Restriction.’
Medications, treatments and rehabilitative therapies shall be administered
as ordered by a physician or dentist subject to the resident’s right to
refuse them. No medication, treatment or changes in medication or
treatment may be administered to a resident without a physician’s or
dentist’s written order which shall be filed in the resident’s
clinical record, except as provided in subd.2.
HFS 83.33 (3) MEDICATIONS. (a) Practitioner’s order. 1.
There shall be a practitioner’s written order for any prescription
medication taken by or administered to a CBRF resident and that medication
shall be labeled by a pharmacist.
HFS 131.36 Health Care Record (3) CONTENT. A patient's
healthcare record shall contain: (f) Physician orders for medications,
procedures, and tests.
HFS 133.20 (4) PHYSICIAN’S ORDERS. Drugs and treatment shall be
administered by the agency staff only as ordered by the attending
physician. The nurse or therapist shall immediately record and sign oral
orders and obtain the physician’s countersignature within 20 calendar
HFS 124.12(5)(b) 11. A statement specifying categories of personnel
duly authorized to accept and implement medical staff orders. All orders
shall be recorded and authenticated. All verbal and telephone orders shall
be authenticated by the prescribing member of the medical staff in writing
within 24 hours of receipt. (See modification per DSL-BQA memo 00-015 at
Hosp00-015.htm [memo replaced by http://www.dhs.wisconsin.gov/rl_DSL/Hospital/hosp06006.htm.)
HFS 88.07(3)(d). Before a licensee or service provider
dispenses or administers a prescription medication to a resident, the
licensee shall obtain a written order from the physician who prescribed
the medication specifying who by name or position is permitted to
administer the medication, under what circumstances and in what dosage the
medication is to be administered. The licensee shall keep the written
order in the resident's file.
HFS 134.60(4)(a). Orders. No medication, treatment or changes in
medication or treatment may be administered to a resident without a
physician’s or dentist’s written order which shall be filed in the
This waiver is applicable only to flu and pneumonia vaccinations.
Hospitals, Nursing Homes and Home Health Agencies should refer to and
follow the federal regulations. A copy of the Federal Regulation changes
to 42 CFR parts 482, 483 and 484 can be found in the Federal Register and
obtained at http://www.access.gpo.gov/nara/cfr/index.html
See, as applicable, the revisions of 42 CFR 482.23(c)(2), 42 CFR
483.40(b)(3) and 42 CFR 484.18(c) on page 61814 of the October
2, 2002 Federal Register (PDF, 65 KB - see last
Community Based Residential Facilities (CBRFs) may have their residents
immunized without a specific written physician order subject to the
following: A CBRF must follow a physician-approved policy for
administering influenza and pneumococcal polysacharride vaccines, complete
an assessment for contraindications for the vaccines and follow its
established policies for administering injectable medications. CBRFs may
wish to contract with pharmacies and various nursing agencies that already
have influenza and pneumococcal immunization programs in place.
For more information please contact Doug Englebert at 608-266-5388.
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