The Vaccinating Adults: A Step-by-Step Guide, developed by staff at the Immunization Action Coalition and reviewed by the Centers for Disease Control and Prevention and the National Vaccine Program Office provides practical information in an easy-to-use format to help you implement or enhance adult immunization services in your health care setting. The Guide also includes an abundance of web addresses and references to assist you in staying up to date with the most current information.
The most important aspect of an immunization program in the office is the designation of an office vaccination coordinator. The coordinator should also have a back-up person trained in all of the duties below. The coordinator will have the following responsibilities:
- Ordering and maintaining vaccines, syringes, and other supplies.
- Development or procurement of medical protocols for vaccination and assuring competence of the staff.
- Following vaccine storage protocols including temperature monitoring and recording.
- Verification of vaccine record system.
- Clear understanding of current immunization recommendations.
One of the first duties of the coordinator will be to gain support and to ensure that all staff has access to the same information while an immunization program is incorporated into the practice. All staff, especially medical and clerical, will be impacted by changes in office procedure and it is imperative they understand and accept the importance of new or expanded vaccine services.
As part of initial planning, the clinic should decide where vaccinations will be given. Basic considerations are:
- Adequate lighting
- Hand washing sink
- Telephone access
- Location of refrigerator that stores vaccines
- The vaccination area must have adequate space for sharps containers, dry storage, forms for record-keeping, and informational materials.
- Adequate space for patients to sit or recline should be available.
Storage and Handling
Appropriate vaccine storage and handling practices are an integral part of the safe and effective delivery of immunizations to patients. The Centers for Disease Control and Prevention (CDC) has multiple resources on proper vaccine storage and handling. Click the links below to access these resources.
- ACOG Storage and Handling.
- CDC Vaccine Storage and Handling.
Depending on the size of the practice and services provided, many of the supplies necessary for the immunization program may already be on hand. Syringes, needles (22–25 gauge in various lengths), alcohol wipes, spot and rectangular Band-Aids, gauze or cotton balls, and medical tape are among the needed basic supplies. Although anaphylactic reactions to vaccines are rare, emergency provisions must be available to treat these reactions. An emergency kit should include, at a minimum:
- Standing orders for medical emergencies
- Aqueous epinephrine
- Ammonia Inhalant Capsules (for fainting)
- Syringes for medication administration
- Adult airways (small, medium, large)
- Adult size pocket mask with one way valve
- Alcohol wipes
- Tongue depressors
- Flashlight with extra batteries
- Timing device
Electronic or paper documentation is an important part of establishing an immunization program. It is also important to document episodes of adverse events in the permanent medical record of the patient (Vaccine Adverse Event Reporting System).
Health care providers who administer one or more of the vaccines covered by the National Vaccine Injury Compensation Program are required to ensure that the permanent medical record of the patient states the following:
- Date the vaccine was administered
- Vaccine manufacturer, lot number, and expiration date
- Name, address (location where the information will be stored), and signature and title of the individual who administers the vaccine (this also may be indicated in a general consent for treatment)
- The date of publication of the Vaccine Information Statement (VIS) given to the patient that is found on the bottom of the back of the VIS
The Advisory Committee on Immunization Practices recommends that this information be kept for all vaccines, not only for those required by the National Vaccine Injury Act.
If patients receive vaccinations outside of the ob-gyn office,it is important to have the proper vaccination documentation to update their immunization records. However, ob-gyns frequently encounter patients who have no adequate documentation of vaccinations. Although vaccinations should not be postponed if records are not readily available, an attempt to locate missing records should be made by contacting previous health care providers. If records cannot be located, patients should be considered susceptible and should be started on the age-appropriate immunization schedule.
- Immunization Information Systems are a useful way to record, track, and manage your patients’ immunizations. Each state has a unique immunization information system, or immunization registry and not all are built to track adult immunizations. Contact state health department immunization program staff to enroll in a state immunization registry.
Standing orders authorize nurses and other trained health care professionals, where allowed by state law, to assess the need for vaccination and to administer vaccinations according to a protocol approved by a physician, institution or authorized practitioner. Standing orders work by enabling assessment and vaccination of the patient without the need for clinician examination or direct order from the attending provider at the time of the interaction. Standing orders have been shown to increase vaccination coverage rates. Vaccine standing orders are updated as needed and reviewed for technical accuracy by immunization experts at CDC. The most current versions can be accessed by going to www.immunize.org/standing-orders.
Take A Stand™: Use Standing Orders to Improve Adult Immunization Rates, developed by the Immunization Action Coalition (IAC), facilitates the implementation of standing orders programs for adult immunizations in physician practices of multiple sizes that are currently providing at least one adult vaccine, and provides basic support to these practices for one year.
Vaccine Information Statements (VIS)
Vaccine Information Statements (VISs), immunization record cards for patients, screening questionnaires, refrigerator temperature logs, Vaccine Adverse Event Reporting System (VAERS) forms (if needed), and billing forms are necessary documents for an immunization program.
Vaccine Information Statements can be downloaded in more than 40 languages. See ACOG's Liability webpage for more information.
Immunization Business & Clinical Strategies for Ob-Gyn Practices
The webinar, “Immunization Business & Clinical Strategies for Ob-Gyn Practices” was presented by ACOG’s Immunization Program in collaboration with the American Academy of Pediatrics (AAP). Building on the successful implementation of immunizations in pediatric care, the webinar focuses on the application of strategies used successfully for years by pediatricians as a model for immunization programs in ob-gyn practices. The webinar was led by a panel of ACOG and AAP experts in infectious diseases and practice management. The goal of the program is to provide concrete business strategies for creating sustainable immunization programs in ob-gyn practices.