COVID-19 Vaccine Update:
In 2020, when the global COVID-19 pandemic changed life as we know it, the importance of vaccines was brought to the forefront of medicine and public health. Implementing successful vaccination programs will be crucial for all types of health care delivery systems in the upcoming months and years.
Specific frequently asked questions (FAQs) regarding the COVID-19 vaccines from the Centers for Disease Control and Prevention (CDC) can be found here.
Additional FAQs regarding how the COVID-19 pandemic affects other routine vaccinations can be found here.
The AMA has developed a collection of resources related to the COVID-19 vaccines, including:
A suite of online courses specific to COVID-19 vaccines, covering COVID-19 vaccine basics, prioritization and delivery, vaccine delivery equity, ethical implications, and public health safeguards, is also available, here.
How will this module help me improve adult vaccination rates in my practice?
Outlines six STEPS to creating a successful team-based adult immunization program
Answers commonly asked questions about team-based adult immunization programs
Provides downloadable tools and training materials to guide you through the process
Vaccines are one of the greatest achievements in the history of medicine and public health. High levels of vaccination in the 20th century led to unprecedented increases in life expectancy and decreases in morbidity and mortality from vaccine-preventable diseases. As a health care professional, you likely understand the importance of adult vaccination; however, the administrative burden, time spent on immunization counseling and financial risks of implementing an adult immunization program may seem daunting. This module will address each of these concerns and provide a comprehensive guide to implementing an adult immunization program in your practice.
Six STEPS for implementing a team-based immunization program
Get your team on board
Train your team
Prepare your team to address common patient questions
Implement a standardized process
Document vaccines given and minimize financial risk
Recognize and reward the participation of your team
STEP 1 Get your team on board
As a champion for adult vaccinations, you set the tone. Your recommendation is the single most important factor in influencing a person’s decision to get vaccinated. Therefore, it is vital that you as a physician convey strong support for vaccination not only to your patients but also to your team members. Getting your entire team on the same page is essential for a successful immunization program.
Vaccine declination form (46 KB) Use the Adult Immunizations: Team Training Program to provide immunization training for your practice or organization. This program contains five training sessions, each approximately 30-60 minutes in length, with speaker notes. You can use this program as is or modify it for your team’s needs. It includes links to several engaging videos that encourage staff participation and conversation.
Quiz Ref IDThe topics of the five training sessions are:
Vaccine fundamentals
Communicating benefits and risks of vaccines
Preparation, administration and adverse event reporting
Storage and handling
Billing, coding and documentation (includes standing orders)
STEP 3 Prepare your team to address common patient questions
Many patients have inaccurate knowledge about vaccinations as a result of misinformation from news outlets (e.g., television, print, social media) as well as from their own families and social circles. However, in most cases, your recommendation will still carry more weight than what patients hear elsewhere, especially in cases where you and your patients have a trusting, long-term relationship.
Quiz Ref IDIt is essential that your team be prepared to address common patient questions and concerns about vaccinations. All team members, from medical assistants to nurses, should feel comfortable telling patients that vaccines are safe, necessary and effective, remembering that anecdotes resonate stronger than data. Provide short stories of patients who have had a vaccine-preventable illness and emphasize that the most common side effect of vaccination is a sore arm. Most patients want to make healthy decisions and will respond to guidance from you and your team.
JAMA Patient Page: Pneumococcal Vaccination (192 KB) JAMA Patient Page: Influenza Vaccine (172 KB)
STEP 4 Implement a standardized process
Quiz Ref IDImplementing standardized processes for vaccinations—from pre-visit planning to assessing, recommending, vaccinating or referring and documenting—will maximize vaccination rates. Empower front desk staff, medical assistants and nurses to get involved in the process. Using standing orders and established protocols can also help save time, improve care and enhance your practice’s bottom line. Using standardized processes also signals to the team that they are all valued members and allows every team member to work to the top of their licensure.
Consider using the standardized processes below. Not all examples may be applicable to your practice, so it will be important to take into account your own practice’s workflow.
Identify which patients are due for which vaccines for the next day’s clinic. Many electronic medical record (EMR) systems have age- and disease-specific reminders for immunizations that are due and using these can save a lot of time. Talk with your EMR vendor about activating these reminders. Have medical assistants perform pre-visit immunization planning for patients using EMR-based alerts and immunization schedules. Once the need is identified for a specific vaccine, the appropriate Vaccine Information Statement (VIS) for that vaccine can be given to the patient upon check-in by the front desk staff (see next bullet point). If your EMR does not provide these reminders, staff can use CDC vaccination schedules or a printable standing orders checklist to determine which vaccines are recommended for each patient. Paper-based or other vaccination needs assessment tools like the CDC online adult vaccine quiz are helpful tools as well. Once patients who are due for a vaccine are identified, they can be recorded on a log sheet for easy reference. An example log sheet is included as a downloadable tool in this module.
Have front desk staff prepare and hand patients a preprinted VIS when they check in. After the clinical staff identifies which patient is due for which vaccine the next day, they write the patient’s name on the appropriate VIS for the front desk staff to hand to the patient upon check-in. This allows patients to have time to read about the vaccine and alerts staff that a vaccine is due. Reassure the front desk staff that they are not responsible for answering any vaccine-related questions from patients and should encourage patients to ask you or a nurse if they have any questions. If a series of vaccinations is required, the front desk staff can also schedule the next vaccination appointment for a patient upon check-out.
Use standing order sets for vaccine administration before the physician component of the appointment and for documentation. These can standardize and streamline practice and may be particularly useful when dealing with vaccines with complicated schedules (e.g., the pneumococcal vaccines Pneumovax [PPSV23] and Prevnar [PCV13]). Your EMR may already have a standing order set for pneumococcal vaccination, but if not, examples of preprinted standing order sets are included in this module.
If your patient declines a vaccination, ask why and then provide further counseling and encouragement. Repetition and a consistent strong recommendation for vaccination by all team members is key.
Use standard protocols for managing and reporting adverse events from vaccinations. Adverse events are uncommon and most often mild, but we all want and need to be prepared for the rare, more serious event if it occurs. Distribute established protocols for managing adverse vaccine-related events in adults and children to your team members. Adverse events should also be reported to the Vaccine Adverse Event Reporting System.
STEP 5 Document vaccines given and minimize financial risk
Minimizing the risk for financial losses starts with reducing wasted vaccines. A few key resources and strategies can help make sure that your revenue matches vaccine costs.
STEP 6 Recognize and reward the participation of your team
Developing, implementing and measuring new projects requires hard work and motivation, especially during the planning and launch phases. It is crucial to have the entire team on board with your immunization program throughout the process. When starting your immunization program, debrief with your team regularly to identify unexpected challenges and troubleshoot how to overcome them. At the end of the day, don’t forget to reward and recognize your team for their hard work.
Implementing an adult immunization program in your practice can save both lives and time while increasing revenue. Proactive and proper training ensures that the work can be safely and effectively carried out by non-physician team members. This team-based approach also improves overall practice morale. Remember that few interventions in history have improved the health of the world population as much as immunizations!
“Standing orders for routine vaccinations are a no-brainer. They decrease physician work load, empower staff and increase vaccination numbers in one fell swoop.”
Your state and county Departments of Health
Access your state and county Departments of Health to see what resources they have to help support your efforts. Follow this link to access the Departments of Health for each state.
Role of Pharmacists in Improving Immunization Rates, American Medical Association, Council on Science and Public Health Report, November 2014.