No matter how many times a provider strongly recommends an overdue vaccination to a patient, some patients simply choose not to follow this advice.1 “It’s so important to tailor your message and take advantage of opportunities to reinforce why the vaccine is needed,” says Marie Brown, MD, an internal medicine specialist at Rush University. “I’ve found in my practice that pointing out that a vaccination can protect others can be a powerful motivator. If it’s a young healthy man sitting in front of you, ask him to get his flu shot to protect his elderly grandmother. If it’s a new grandmother, explain to her how important a Tdap vaccine is for protecting her baby granddaughter from whooping cough. You may be surprised to find that many patients will receive a vaccine to protect others but wouldn’t do so just for themselves.”
Recently, Dr. Brown was faced with one of those opportunities that shouldn’t be missed. A patient she was seeing had a reminder pop-up in her chart that she was overdue for a Tdap vaccine. The patient had been declining this vaccination for decades, always saying “she felt fine and didn’t need it, so maybe another time.” But at this most recent visit, she shared that she was in a rush to finish her appointment because her daughter-in-law was in labor about to deliver her first grandchild. Dr. Brown quickly emphasized how important Tdap was so that she didn’t expose her new grandchild to whooping cough. The woman agreed to be vaccinated. At a return appointment, the patient explained that she not only shared with her daughter-in-law how she had been vaccinated to protect the baby, but became the gatekeeper for other visitors to make sure that they were vaccinated before meeting the newborn. The woman beamed as she relayed how much the new mother appreciated this action. This story was celebrated in the clinic with a shout out during a weekly team meeting.
Dr. Brown’s practice has standing orders and specific processes in place to streamline immunization as soon as the patient provides consent. This starts before a patient even walks through the clinic door. During pre-visit planning, the medical assistants (MAs) check the patient’s chart to see if any immunizations are due. If there are any, the MA prints the Vaccine Information Statement (VIS) for that vaccine and has it ready to go for the next day. Then, the VIS is given to the patient, sometimes before the patient is roomed. If it’s influenza season, typically January through March, the VIS is handed to the patient at check in so they can peruse it as they wait. During other seasons or for different vaccinations, the VIS is provided during rooming. Standing orders allow MAs to administer some vaccines, such as pneumonia vaccines, before Dr. Brown enters the exam room.
In addition to finding opportunities to encourage patients to be immunized and making administration of the vaccine easy for patients and staff, it’s important to celebrate the small wins that contribute to a successful adult immunization program. In Dr. Brown’s clinic, this means giving shout outs in team meetings as well as designating a Chief Vaccination Officer (CVO).2 The CVO is a very enthusiastic MA who is nominated by her colleagues to serve in this role. This designation is supported by the American College of Physicians as a way to improve vaccination rates around the country. The MA receives a $150 check to provide lunch for his or her team and takes part in supplemental training to be a vaccine champion and resource for the team. In Oak Park, the CVO spreads this knowledge through ongoing training at the practice. The MA is also a champion for staff and providers to stay current with their own vaccinations.
Since implementing these changes, Dr. Brown’s practice has seen vaccination rates double over the last eight years, from 40 percent to 80 percent. She is also proud to report that she sees very few influenza cases during flu season due to high flu vaccination rates, which makes a big difference for general patient care as many other practices are seeing numerous emergency cases in winter and spring.
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