CMS Manual System - Louisiana Department of Health and Hospitals

technique requires a comparison of the number of doses remaining in a supply of drugs with the
number of days the drug has been in use and the directions for use. For example, if a drug were
in use for 5 days with direction to administer the drug 4 times a day, then 20 doses should have
been used. If a count of the supply of that drug shows that only 18 doses were used (i.e., two
extra doses exist) and no explanation for the discrepancy exists (e.g., resident refused the dose,
or resident was hospitalized), then two omission errors may have occurred.
Use the dose reconciliation technique in facilities that indicate the number of drugs received, and
the date and the specific ―pass‖ when that particular drug was started. Unless this information is
available, do not use this technique. If this information is not available, there is no Federal
authority under which the survey team may require it, except for controlled drugs.
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F334
§483.25(n) Influenza and pneumococcal immunizations---
(1) Influenza. The facility must develop policies and procedures that ensure that--
i. Before offering the influenza immunization, each resident or the resident’s legal
representative receives education regarding the benefits and potential side effects
of the immunization;
ii. Each resident is offered an influenza immunization October 1 through March 31
annually, unless the immunization is medically contraindicated or the resident has
already been immunized during this time period;
iii. The resident or the resident’s legal representative has the opportunity to refuse
immunization; and
iv. The resident’s medical record includes documentation that indicates, at a
minimum, the following:
(A) That the resident or resident’s legal representative was provided education
regarding the benefits and potential side effects of influenza immunization;
and
(B) That the resident either received the influenza immunization or did not
receive the influenza immunization due to medical contraindications or
refusal.
(2) Pneumococcal disease. The facility must develop policies and procedures that ensure
that—
i. Before offering the pneumococcal immunization, each resident or the resident’s
legal representative receives education regarding the benefits and potential side
effects of the immunization;