Standards For Adult Immunization Practice Research Articles

A multisite initiative to assess the immunization status of medical oncology patients.

289 Background: The Swedish Cancer Institute (SCI) is committed to holistic care and recognizes immunizations are an essential component to quality outcomes. In 2022 the SCI was selected to participate in the Specialty Societies Advancing Adult Immunization (SSAAI) project supported by the Centers for Disease Control and Prevention (CDC) with a goal of incorporating the CDC Standards for Adult Immunization Practice into medical oncology clinical care. The CDC Standards for Adult Immunization Practice are assess, recommend, administer or refer, and document. Recognizing immunization status is not routinely assessed, this quality initiative aimed to increase assessment of immunization status in medical oncology across 7 network clinics on 4 campuses to above 50 % by the end of 2023. Methods: All team members completed the ASCO Quality Training Program. The Plan Do Study Act (PDSA) framework was selected. Assessment was defined as having completed the Immunization Activity Record within the Epic Medical Record system, which includes reconciliation with the Washington state immunization registry. Data was initially abstracted manually to determine the baseline assessment rate until an automated method was developed. A Fishbone diagram determined the top barrier was the lack of awareness about this functionality and lack of training around the task. A workflow diagram and standard operating procedure were implemented. Clinic staff were trained on the new workflow when rooming patients. A small pilot with one clinic of solid tumor medical oncology clinics was completed. Patients included were on active treatment and seen face to face within the clinic. The standardized process and tools were refined, and problem areas addressed. The work was then expanded to all seven of the SCI network medical oncology clinics including hematology as the final PDSA cycle using the same training, process and tools. Results: The Epic Immunization Activity Record completion rate went from less than 1% of solid tumor patients with an active systemic treatment plan to 61% in the pilot project. After two additional PDSA cycles to refine the steps and target problem areas, the rate improved to 67% over a 3-month period. The PDSA cycle was expanded to bring the refined process to all 7 network clinics with a baseline assessment rate of 6% which increased to 45% after interventions within a 3-month period and concluding the 2023 year. Conclusions: Developing tools and implementing a new workflow for immunization assessment yielded a significant improvement in assessment rates thereby setting a foundation of assessment utilizing the CDC Standards for Immunization Practice. The use of concrete written tools improves the sustainability of the changes. Additional tools and refinement of existing tools will be studied to improve the current rate and sustain the gains. Reference: Standards for Adult Immunization Practices | CDC .

Strengthening vaccination assessment at a southern oncology center: A quality improvement endeavor.

322 Background: The 2013 revision of the Standards for Adult Immunization Practice by the National Vaccine Advisory Committee (NVAC) mandated healthcare professionals to evaluate and ensure adult patients' immunization. Additionally, the 2024 recommendations from the American Society of Clinical Oncology (ASCO) stressed the importance of determining vaccination status of adults newly diagnosed with cancer, to safeguard against vaccine-preventable diseases. Our 2022-2023 cumulative assessment rate for flu vaccination was 64%, and COVID-19 vaccination status was not being assessed in the electronic medical record (EMR). This prevented us from identifying patients who would benefit from vaccination. Methods: A quality improvement initiative was initiated at Norton Cancer Institute – Downtown Office, focusing on enhancing vaccination assessment. Launching in October 2024, the initiative targeted flu and COVID-19 vaccination assessment, with updates to flu assessment questions and the implementation of a COVID-19 assessment flowsheet in the EMR. Best practice advisories (BPAs) were employed to prompt nurse clinicians and providers to order vaccines based on patient responses. Staff compliance was reinforced through tailored training sessions for medical assistants responsible for initial patient assessments, with an emphasis on reconciling external records to improve assessment accuracy. A de-identified data set was created to analyze workflow compliance, the data was abstracted from the relational databases of our institution's EMR system. Abstraction queries were written in SQL using the Microsoft SQL Server Management Studio platform. Results: Following the implementation of the initiative, there was an increase in vaccination assessment completion rates for both Flu and Covid-19. Flu assessment rates improved from 64% at the end of the 2022-2023 flu season to 76% during the 2023-2024 flu season. The implementation of Covid-19 Vaccination assessment workflow also resulted in increased assessment rates each month of the initiative, starting in October with initial rate of 36% and ending in March with 67% cumulative assessment rate. Conclusions: The targeted intervention increased vaccination assessment practices within the oncology setting; by improving clinical workflow to better align with NVAC guidelines and ASCO recommendations for assessment of vaccination status. By Improving vaccination assessment processes our hope is to improve rates of vaccination for oncology patients.

Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.

Surveillance of Vaccination Coverage Among Adult Populations -United States, 2018.

Implementation of the Standards for adult immunization practice: A survey of U.S. Health care providers

The revised Standards for Adult Immunization Practice (“Standards”), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists.Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.

U.S. clinicians’ and pharmacists’ reported barriers to implementation of the Standards for Adult Immunization Practice

BackgroundThe Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians’ (physicians, physician assistants, nurse practitioners) and pharmacists’ reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients’ attitudes toward vaccines were evaluated. MethodsData from non-probability-based Internet panel surveys of U.S. clinicians (n = 1714) and pharmacists (n = 261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated. ResultsHigh percentages (70.0%−97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians’ and 38.4% pharmacists’ submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS. ConclusionAlthough many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers’ reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.

Clinicians’ and Pharmacists’ Reported Implementation of Vaccination Practices for Adults

IntroductionDespite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians’ and pharmacists’ self-reported implementation of the Standards for Adult Immunization Practice (“the Standards”; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems).MethodsTwo Internet panel surveys (one among clinicians and one among pharmacists) were conducted during February–March 2017 and asked respondents about their practice’s implementation of the Standards. T-tests assessed associations between clinician medical specialty, vaccine type, and each component of the Standards (March–August 2017).ResultsImplementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines.ConclusionsThis report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.

Pneumococcal Vaccination Among Medicare Beneficiaries Occurring After the Advisory Committee on Immunization Practices Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged ≥65 Years.

On September 19, 2014, CDC published the Advisory Committee on Immunization Practices (ACIP) recommendation for the routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, to be used in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) (1). This replaced the previous recommendation that adults aged ≥65 years should be vaccinated with a single dose of PPSV23. As a proxy for estimating PCV13 and PPSV23 vaccination coverage among adults aged ≥65 years before and after implementation of these revised recommendations, CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS). Claims from any time during a beneficiary's enrollment in Medicare Parts A (hospital insurance) and B (medical insurance) since reaching age 65 years were assessed among beneficiaries continuously enrolled in Medicare Parts A and B during annual periods from September 19, 2009, through September 18, 2016. By September 18, 2016, 43.2% of Medicare beneficiaries aged ≥65 years had claims for at least 1 dose of PPSV23 (regardless of PCV13 status), 31.5% had claims for at least 1 dose of PCV13 (regardless of PPSV23 status), and 18.3% had claims for at least 1 dose each of PCV13 and PPSV23. Claims for either type of pneumococcal vaccine were highest among beneficiaries who were older, white, or with chronic and immunocompromising medical conditions than among healthy adults. Implementation of the National Vaccine Advisory Committee's standards for adult immunization practice to assess vaccination status at every patient encounter, recommend needed vaccines, and administer vaccination or refer to a vaccinating provider might help increase pneumococcal vaccination coverage and reduce the risk for pneumonia and invasive pneumococcal disease among older adults (2).

U.S. Immunization program adult immunization activities and resources

ABSTRACTAdults are recommended to receive vaccines based on their age, medical conditions, prior vaccinations, occupation and lifestyle. However, adult immunization coverage is low in the United States and lags substantially below Healthy People 2020 goals. To assess activities and resources designated for adult immunization programs by state and local health department immunization programs in the United States, we analyzed 2012 and 2013 data from the Centers for Disease Control and Prevention's (CDC) Program Annual Reports and Progress Assessments (PAPA) survey of CDC-funded immunization programs. Fifty-six of 64 funded US immunization programs' responses were included in the analysis. Eighty-two percent of (n = 46) programs reported having a designated adult immunization coordinator in 2012 and 73% (n = 41) in 2013. Of the 46 coordinators reported in 2012, 30% (n = 14) spent more than 50% of their time on adult immunization activities, and only 24% (n = 10) of the 41 adult coordinators in 2013 spent more than 50% of their time on adult immunization activities. In 2012, 23% (n = 13) of the 56 programs had a separate immunization coalition for adults and 68% (n = 38) included adult issues in their overall immunization program coalition. In 2013, 25% (n = 14) had a separate adult immunization coalition while 57% (n = 32) incorporated adult immunizations into their overall immunization program coalition. The results indicate substantial variation across the US in public health infrastructure to support adult immunizations. Continued assessment of adult immunization resources and activities will be important in improving adult immunization coverage levels though program support. With many programs having limited resources dedicated to improving adult immunization rates in the in US, efforts by the health departments to collaborate with providers and other partners in their jurisdictions to increase awareness, increase the use of proven strategies to improve vaccination of adults, and implement the Standards for Adult Immunization Practice may lead to improved adult immunization coverage and fewer illnesses, hospitalizations and deaths from vaccine preventable diseases.

NVAC: New standard, schedule updates for adult immunizations

Abstract Now that the revised Standards for Adult Immunization Practice from the National Vaccine Advisory Committee (NVAC) are in place for all vaccine providers, what does this mean for pharmacists?

Establishing patient referral relationships to increase vaccination rates

Earlier this year, the National Vaccine Advisory Committee (NVAC) released standards for adult immunization practice aimed at increasing vaccination rates among this patient population. A key recommendation was to establish patient referral relationships between nonimmunizing and immunizing providers to meet patients' needs while protecting the community from vaccine-preventable diseases.

Pharmacy-based immunizations growing, improving

Using an ever-increasing network of patient-referral relationships and taking steps to improve documentation practices, pharmacists are increasing the volume and diversity of immunization services they offer in the pharmacies of America, according to a 2013 survey conducted by APhA. Using an ever-increasing network of patient-referral relationships and taking steps to improve documentation practices, pharmacists are increasing the volume and diversity of immunization services they offer in the pharmacies of America, according to a 2013 survey conducted by APhA. The national survey assessed pharmacy-based immunizations on behalf of the U.S. Department of Health & Human Services National Vaccine Program Office. Links to the Internet-based survey were e-mailed to 32,603 pharmacists in all pharmacy practice settings from August 24 to September 14, 2013, and 2,351 pharmacists responded. Overall, 77% of pharmacy practice sites were offering vaccinations on a walk-in basis without an appointment. Compared with 2012 survey results, the use of appointment-based or time-restricted access decreased, with only 36% of practice sites in 2013 offering vaccinations by appointment, compared with 41% in 2012. In addition, immunization services offered via instore clinics remained low, with 18% of respondents selecting this option, down from 26% in 2012. Influenza remained the most commonly administered vaccine (88%). However, the majority of practice sites also reported the current administration of pneumococcal (77%), herpes zoster (75%), and tetanus (57%) vaccines. Fewer than one-half of the practice sites were reported as currently administering vaccines for hepatitis B (47%), hepatitis A (43%), meningococci (43%), human papillomavirus (37%), international travel (25%), and pediatric patients (10%). The percentage of currently administered vaccines was higher for most categories compared with results of the 2012 survey (e.g., herpes zoster vaccine administration was 57% in 2012). To successfully expand immunization services beyond influenza, pharmacists ranked their highest priorities (on a 10-point scale) as obtaining the support of public health (7.02), pharmacy management (6.35), and medicine (6.32). Other priorities included training pharmacists on how to counsel patients or offer additional vaccinations (6.25), and aligning or including incentives in performance evaluations of immunizing pharmacists (6.19). More than one-half of pharmacies administer influenza, pneumococcal, zoster, or tetanus vaccines. The National Vaccine Advisory Committee's (NVAC) updated Standards for Adult Immunization Practice support the establishment of patient referral relationships to minimize any potential patient barriers to vaccination (see related article on page 66). The 2013 results show that referrals are happening across various groups. Pharmacists reported an increase in patient referrals from physicians (88% vs. 84% in 2012) as a result of various factors, including vaccine availability, cost, reimbursement, and time. In addition, 29% of responding pharmacists reported referring patients to physician offices to address immunization issues. Among all practice sites, 22% of respondents were referring patients to other immunizing pharmacists when access was not available at their primary pharmacy practice site. The majority of respondents (56%) reported that other pharmacists had referred patients to them, and 16% of practice sites noted referring patients to their own in-store clinic practitioner. Nearly one-quarter of respondents (24%) had referred patients to the public health department. Respondents practicing in independent pharmacies (32%) were most likely to make such referrals. One in 10 practice sites (9%) reported that their immunizing pharmacists have protocols or standing orders with the public health department. Another important component of the updated NVAC standards is appropriate documentation that takes advantage of electronic medical records and state immunization registries. The survey noted that 91% of respondents' practice sites maintain documentation of a patient receiving a vaccination in the pharmacy, 69% provide patients with a copy of their consent form, and 53% enter the vaccination into the patient's medical record. In addition, more than 6 in 10 respondents (64%) were providing documentation of the patient's vaccinations directly to the patient's physician. Overall, 35% of respondents were entering a patient's vaccinations into an immunization registry, and 28% noted submitting all immunizations to state or local immunization registries. Only a small percentage of respondents reported submitting adult (7%), childhood (6%), adolescent (5%), and influenza (5%) immunizations to state or local registries; 11% said they were not permitted to access state and local immunization registries. The results of APhA's 2013 immunization survey show the increased administration of numerous vaccines by pharmacists, a growing network of patient referral relationships, and steps being taken toward improved documentation practices. Additional improvements can be made in the coming years by focusing on initiatives that improve immunization access and use of immunization registries.

It takes a village: NVAC standards emphasize importance of immunization neighborhood

All health professionals should encourage their adult patients to receive needed vaccines, the National Vaccine Advisory Committee (NVAC) said in updated Standards for Adult Immunization Practice. This responsibility is the same for health professionals who administer vaccines and for those who don't, NVAC emphasized.

Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice

Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice

Standards for adult immunization practice

Standards for adult immunization practice

Vaccine-Preventable Diseases Among Adults: Standards for Adult Immunization Practice

Vaccine-Preventable Diseases Among Adults: Standards for Adult Immunization Practice

From the Centers for Disease Control. Vaccine-preventable diseases among adults: standards for adult immunization practice

From the Centers for Disease Control. Vaccine-preventable diseases among adults: standards for adult immunization practice

Standards for adult immunization practice

Standards for adult immunization practice