Improving Adult Immunization Delivery

Background:
Adult immunization rates continue to lag behind rates in pediatric populations, due to a variety of system, practice, and patient level barriers that have been overcome in effective childhood immunization initiatives.

Setting:
Denver Health is an integrated safety net healthcare delivery system, consisting of a 500-bed public hospital, Level I trauma center, the County Public Health Department, and community health primary care clinics spanning 9 different geographic locations.

Population:
The target population was adult patients > 18 years age with at least one medical visit to an internal or family medicine primary care site. The goal was to ensure these adults received pneumococcal, tetanus and/or influenza vaccines during a visit if recommended per ACIP guidelines.

Project Description:
Our agency developed an initiative for use with our adult population based upon proven strategies that increased immunization rates in our pediatric and adolescent populations. Key stakeholders joined with our state nonprofit healthcare quality improvement organization to assess present adult immunization practices. Adult immunization algorithms (Clinical Decision Support Tools, CDSTs) were developed and programmed into the database used during routine patient check-ins. Utilization of the CDST under routine standing orders allows the nursing staff to administer and document routinely recommended adult vaccines.

Results/Lessons Learned:
Clinics and individual staff members initially had differing approaches to patient immunization processes. Engagement of all clinic staff in reviewing current adult immunization practices and planning for incorporation of standing orders and CDST was key in determining site-specific success. A standing order policy that relies on CDST technology can be implemented by clinical teams and incorporated into the workflow of nursing staff. Vaccines administered are captured in the registry providing seamless immunization services throughout the agency and improving adult immunization rates. Adult ambulatory care pneumococcal and influenza immunization rates over project implementation will be displayed.