1. Tools to Improve Immunization Rates in a Community Health Center
Frene’ LaCour-Chestnut, M.D.
Internal Medicine-Pediatrics
Assistant Professor
Baylor College of Medicine

2. Disclosure
I do not have any personal or financial obligations to disclose

3. Objectives
Discuss the development and use of Standing delegation orders for immunizations
Explain the importance and impact of coupling vaccines on immunization rates
Discuss the importance of immunization education for all clinic staff
Demonstrate how incorporating vaccine pre-visit planning can improve vaccination rates

8. P.I.E.C.E.S P: Previsit planning I: Immunization champion E: Education
Coupling Vaccines
EHR
Standing Delegated Orders
P: Previsit planning
I: Immunization champion
E: Education
C: Coupling vaccines
E: EHR
S: Standing delegated orders

9. Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders

10. Immunization Champion

11. Immunization Champion
Desire
Passion
Resourceful

12. http://4pillarstoolkit. pitt

13. 4 Pillars™ Immunization Toolkit
Pillar 1: Convenience and Easy Access
Pillar 2: Patient Notification
Pillar 3: Enhanced Vaccination Systems
Pillar 4: Motivation

14. Education Vaccine education for ALL clinic staff Immunization Champion
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders
Vaccine education for ALL clinic staff

15. Education Vaccine education for ALL clinic staff Physicians Providers
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders
Vaccine education for ALL clinic staff
Physicians
Providers
Pharmacists
Nursing staff
Medical Assistants
Front desk clerks
Administrators
EVERYONE!!!

16. Pair/Share
Innovative ideas to educate providers and staff on vaccinations

17. Education Vaccine education for all clinic staff
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders
Vaccine education for all clinic staff
Short quizzes with prizes
Lunch and learn
Vaccine updates and reminders
at regular staff meetings
Vaccine question of the week
Friendly competition
Provider feedback/benchmarks
VIS
Immunize.org

18. Recommend
Most adults believe that vaccines are important and are likely to get them if recommended by their healthcare professional
Strong and Clear recommendation

20. S.H.A.R.E for a Strong Vaccine Recommendation
S: Share
H: Highlight
A: Address
R: Remind
E: Explain

22. Standing Delegated Orders
Standing Orders
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders

23. Medical Assistant Standing Orders Training Video

24. Standing Orders Examples Available at www.immunize.org/standing-orders
The standing orders template may be adapted per a practice/system’s discretion without obtaining permission from IAC (Immunization Action Coalition). As a courtesy, please acknowledge IAC as its source.
Updated yearly with new recommendations (usually February)
Extensively studied (Nowalk et al)

25. Administer
It is important to think of and offer vaccines at EVERY visit
Especially in a community health center you may not know when your patient is returning
Utilize sick and chronic care visits to offer vaccinations
Couple vaccines together (ex: influenza and pneumococcal vaccine)
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders

26. Reducing missed opportunities
Coupling vaccine administration
Addressing vaccination status at EVERY visit
Using influenza vaccination season to offer other vaccines
Express vaccination clinics at convenient times
Chyongchiou J. Lin et al BMC Infect Dis. 2016; 16: Nov 3. doi:   /s

27. EHR Utilize your EHR to your advantage Vaccine forecaster
Document previously given vaccines
Patient reminders via patient portal or
After visit summary or appointment reminder cards
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders

28. Poll everywhere
Where would you like to see your clinic or organization improve its use of the EHR to improve vaccination rates?
Send out patient vaccination reminders
Schedule vaccine appointments via online portal
Vaccination reminders via pop-ups or alerts during patient appointments
Other ideas

29. Pre-Visit Planning Utilize your huddle to identify needed vaccines
Allow vaccination administration prior to provider visit or after visit
Communication between nursing staff and provider
Immunization Champion
Education
Pre-visit planning
Coupling Vaccines
EHR
Standing Delegated Orders

30. Example of Pre-Visit Planning
Discuss process that nurse looks at schedule, identifies patient and for example use 51 yo man with Diabetes
Nursing staff then clicks on HM tab

31. Example of Pre-Visit Planning
Nursing staff documents in the notes section what preventive measures are due or need to be completed at the visit today. When the patient arrives, the nursing staff can begin offering those needed services and education. For example, If a colon cancer screening test is due then nurse plays video on proper collection of FIT. If a patient is due for vaccines then they are offered up front before the physician arrives to the room. Resident physicians are reminded when they look at their schedule and if time/schedule permits in person by the nursing staff regarding preventive services that need orders or are due today. Nursing staff also communicates if patient has additional questions or has refused those services.

32. Homework Self Assessment
Which PIECES of the pie can you address to work towards improving your vaccination rates
Discuss with your partner one actionable item to improve your vaccination rates based on the information presented here today

33. References
Healthy People 2020: Immunization and Infectious Diseases Objectives [ objectives/topic/immunization-and-infectious-diseases/objectives] Accessed 15 March 2018
4 Pillars™ Immunization Toolkit · University of Pittsburgh ©2018
Chyongchiou J. Lin et al. Using the 4 pillars™ practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial. BMC Infect Dis Nov; 16: 623. Published online 2016 Nov 3.
Nowak GJ, Sheedy K, Bursey K, Smith TM, Basket M. Promoting influenza vaccination: Insights from a qualitative meta-analysis of 14 years of influenza-related communications research by U.S. Centers for Disease Control and Prevention (CDC) Vaccine. 2015;33(24):2741–2756.
Darren, L et al. Interventions to Improve Influenza and Pneumococcal Vaccination Rates Among Community-Dwelling Adults: A Systematic Review and Meta-Analysis. Ann Fam Med Nov; 10(6): 538–546.
Thomas RE et al. Systematic review of interventions to increase influenza vaccination rates of those 60 years and older. Vaccine ;28(7):
Nowalk MP, Zimmerman RK, Feghali J. Missed opportunities for adult immunization in diverse primary care office settings. Vaccine. 2004;22(25-26):3457–3463
Guide to Community Preventive Services [ factsheet-and-insert.pdf]
Immunization Action Coalition. Vaccine Education Powerpoint Resources.
Immunization Action Coalition. Suggestions to Improve Your Immunization Services Checklist.