Vaccination Module
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The Vaccination Module targets the healthcare facility’s inpatient population, who are greater than 6 months of age. Two separate approaches (Summary Method or Patient-Level Method) are used to report data for the Vaccination Module. The module can be completed using either retrospective medical record review (Summary Method or Patient-Level Method) or prospective surveillance (Patient-Level Method). Either method may be used during the influenza season. When vaccinations for more than one subtype are recommended during a season, use a single method and report data separately for each vaccination subtype. For example, report a Summary Method record for seasonal vaccination and one for the non-seasonal subtype. Multiple admissions by the same patient during the same month should be evaluated as separate encounters for this module.
The minimum requirement to participate in this module is one month during the influenza season (September through April), but maximal benefit is obtained by completing the module for each month of the entire influenza season.
Corresponding Materials
Protocols
- Vaccination Module [PDF - 135 KB] January 2012
Training
Forms
Summary Method
- 57.130 Vaccination Monthly Monitoring Form-Summary Method [PDF - 43 KB] January 2012
- Customizable form [DOC - 33 KB] Feb 2012
- Form Instructions [PDF - 84 KB] Feb 2012
Patient-Level Method
- 57.131 Vaccination Monthly Monitoring Form—Patient-Level Method [PDF - 43 KB] January 2012
- Customizable form [DOC - 32 KB] Feb 2012
- Form Instructions [PDF - 80 KB] Feb 2012
- 57.133 Patient Vaccination [PDF - 52 KB] January 2012
- Customizable form [DOC - 39 KB] Feb 2012
- Form Instructions [PDF - 89 KB] Feb 2012
- 57.134 Influenza Vaccination Standing Orders [PDF - 95 KB] January 2012
- Customizable form [DOC - 30 KB] Feb 2012
- Form Instructions [PDF - 69 KB] Feb 2012
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