Consider implementing one or more of the following strategies to improve rates in your office.
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 based on the harmonized immunization schedule. Standing orders should include procedures for vaccinating eligible patients and contraindications. Access sample standing orders for vaccines. 1. Also consider making a change in your office with these practice-change tools: 1 The Community Guide. Community Preventive Services Task Force (http://www.thecommunityguide.org/vaccines/standingorders.html).
Provider prompts usually consist of electronic prompts in Electronic Health Records (EHRs) or notes/flags in paper charts. Most EHR provider prompts are automatic pop-up alerts that notify the viewer that the 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. Many EHRs have provider prompts pre-installed that can be customized in the office. Notes/flags in paper charts must be added manually, after review of the chart for due vaccines.
Hold Family-friendly Office Hours
Holding vaccination clinics with special hours (evenings and/or Saturdays) at your practice allows for more opportunities for busy families to access vaccination services. This has been proven to work especially well for influenza vaccine.
Assign an Immunization Champion for Your Practice
An immunization champion can serve as a steward and advocate of immunizations in your practice. This role can be filled by any clinical staff. Being the immunization champion should be written into that job description and that staff should have time devoted to perform those tasks. Offices should cross-train staff and appoint a different person to fill-in and complete these duties in case the immunization champion is unavailable. It is also suggested, if the immunization champion is not a physician, that a physician provides oversight to the immunization champion. An immunization champion would be responsible for the following:
- Unloading, stocking, and monitoring vaccines
- Vaccine ordering
- Managing vaccine inventory
- Implementing office-wide strategies to increase vaccination coverage
Provide a Strong Recommendation
Studies have shown that parents trust their pediatrician's guidance2. Be sure to give a strong recommendation for all vaccines on the current immunization schedule. It is important to state that you recommend all vaccines on the schedule and not merely mention that they are available. For example, some providers may shy away from discussing the HPV vaccine. It is especially important to strongly recommend HPV vaccine, as parents often have more questions about it.
If you don't already, consider these tools to help you make a strong recommendation for vaccines in your practice:
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.
Providers change their behavior (e.g., clinical practices) based on feedback that they are different from those of their peers. Consider running an immunization rate report through your EHR or perform a chart audit to determine the percentage of your patients that are up-to-date on immunizations. Benchmark this data against yourself annually. You can also benchmark this data against the national and state (or city) data from the National Immunization Survey.
Educate Patients and Their Parents
Educate parents and patients about each recommended vaccine and the disease it prevents. Let parents 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 parents 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 parents time to consider their questions, find answers, and discuss their most serious concerns with their pediatrician.
AAP Risk Communication Videos
AAP Communication with Families Web page
CDC Provider Resources for Immunization Conversations with Parents
Include All Recommended Vaccinations at Every Visit
It is important to vaccinate whenever possible, because you don't know when a patient will be back in your office. Use sick-child and chronic care visits as a time to immunize. Be sure to check what vaccinations, if any, are due every time a patient is in the office. Always screen for contraindications. Most vaccines can be given even if the child has a mild illness.3
3 CDC. Chart of Contraindications and Precautions to Commonly Used Vaccines. 2011. Accessed on April 12, 2013 at: http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm.
Hold Team Huddles
Many practices have implemented daily clinical team meetings or "huddles" to improve the flow and quality of care they deliver. These meetings can focus on pre-visit planning, strategizing treatment plans for patients with special or complex needs, and addressing daily workflow and communication issues.4 Incorporating immunization planning into these meetings can increase immunization rates.
4 Rodriguez HP1, Meredith LS, Hamilton AB, Yano EM, Rubenstein LV. "Huddle up!: The adoption and use of structured team communication for VA medical home implementation." Health Care Manage Rev. 2014 Jul 15