Office Strategies for Improving Immunization Rates

Increase your practice’s immunization rates by using evidence-based strategies. Consider implementing one or more of the following strategies to improve your rates.

Standing Orders

Standing orders for immunizations include office policies, procedures, and orders to provide recommended immunizations to patients. For example, a standing order might be in place to instruct health care personnel (as allowed by the state) to give a specific vaccine to all patients for whom the vaccine is recommended. Standing orders should include procedures for vaccinating eligible patients and contraindications. Access sample standing orders for vaccines. ¹ Consider using these practice-change tools to implement standing orders in your practice: 

• Sample Standing Orders Project Charter 
• Sample Standing Orders Plan-Do-Study-Act (PDSA) Cycle 1 
• Sample Standing Orders PDSA Cycle 2

^{1 The Community Guide. Community Preventive Services Task Force (https://www.thecommunityguide.org/sites/default/files/assets/Vaccination-Standing-Orders.pdf).}

Provider Prompts

Remind yourself to offer vaccines through prompts. Provider prompts usually consist of electronic prompts in EHRs or notes/flags in paper charts. Most EHR provider prompts are automatic pop-up alerts that notify the viewer a patient is due/overdue for an immunization. Other EHR provider prompts may show up as​ a "to-do" task, even if the patient is not scheduled that day for an appointment. You may ask your EHR vendor to customize or activate pre-installed prompts. Notes/flags in paper charts must be added manually, after review of the chart for due vaccines.

Hold Family-friendly Office Hours

Create more opportunities for busy families to access vaccination services by holding vaccination clinics with varied hours (evenings and/or Saturdays). This has been shown to work especially well for influenza vaccine. 

Assign an Immunization Champion for Your Practice

Appoint an immunization champion to serve as a steward and advocate of immunizations in your practice. Fill this role with a member of your clinical staff. Write the immunization champion role into the appropriate job description and ensure that this individual has dedicated time to performing these tasks. Cross-train staff and appoint a different person to fill-in and complete these duties in case the immunization champion is unavailable. If the immunization champion is not a physician, we suggest that a physician provides oversight to the immunization champion. Tasks assigned to an immunization champion may include the following:

• Unloading, stocking, and monitoring vaccines
• Vaccine ordering
• Managing vaccine inventory
• Implementing office-wide strategies to increase vaccination coverage

Provide a Strong Recommendation

Always give a strong recommendation for all vaccines on the current immunization schedule. Parents trust your guidance². State that you recommend all vaccines on the schedule (e.g., “Today, your child needs the HPV vaccine to protect them against cancers and other diseases caused by HPV.”) and not merely mention that they are available (e.g., “Schools require the Tdap and meningococcal vaccine. We also recommend the HPV vaccine today.”) Consider these tools to help you make a strong recommendation for vaccines in your practice:

• Sample Vaccine Recommendations Project Charter
• Sample Vaccine Recommendations PDSA Cycle 1
• Sample Vaccine Recommendations PDSA Cycle 2

^{2 Freed GL, Clark SJ, Butchart AT, Singer DC, and Davis MM. Sources and Perceived Credibility of Vaccine-Safety Information for Parents. 2011. Pediatrics, 127, 1, Supplement 107-112.}

Provider Feedback

Providers change their behavior (e.g., clinical practices) based on feedback. Consider running an immunization rate report through your EHR or perform a chart audit to determine the percentage of your patients who are up-to-date on immunizations. Benchmark this data against yourself annually. You can also benchmark this data against other pediatricians in your practice or national and state (or city) data from the National Immunization Survey. ​​

• Immunization Assessment – Sample PDSA
• AIM Statement
• Data Collection
• Run Chart

Educate Patients and Their Families

Educate families and patients about each recommended vaccine and the disease it prevents. Let families know that vaccines are safe and effective, and that not vaccinating could put their children at risk for very serious diseases. Take every opportunity to educate families and patients. Let them know at each visit what vaccines they can expect at their next health supervision appointment and provide handouts on these vaccines and diseases. This allows families time to consider their questions, find answers, and discuss their most serious concerns with their pediatrician.

Resources

• AAP Immunization Communication Aids