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Immunize at every opportunity

Adolescents do make office visits, but opportunities are often missed to provide age-appropriate vaccines that are due at that time. Consider every patient encounter a potential vaccine visit, starting with well visits and annual physicals (the American Academy of Pediatrics recommends a comprehensive physical exam for all patients from 11–21 years of age). Immunization opportunities also arise during sports and camp physicals; acute care and follow-up visits; visits for care of chronic illness; and visits for annual influenza immunization.

Use a reminder and recall system

The Centers for Disease Control and Prevention (CDC) recommends these systems, which typically include computer-generated reminders to you and your staff that a patient is due for one or more vaccines. Messages can be delivered to patients and parents via telephone calls, letters, postcards, e-mail, or text messages or social media, noting that vaccines are either due (reminder) or past due (recall).

Implement standing orders

Standing orders authorize nurses, pharmacists, and other appropriately trained health care personnel, where allowed by state law, to assess a patient’s immunization status and administer vaccinations according to a protocol approved by an institution, physician, or other 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.

Take part in an immunization registry

A population-based immunization registry provides ready access to a comprehensive immunization record for every patient, even one who has been vaccinated by a number of different providers. These Immunization Information Systems (IIS) may be local, state, or regional.

Review your patients’ vaccination histories

Prior to visits, review the patient’s immunization record (both your medical record and information available in the immunization registry) and flag the chart if the patient is due or overdue for vaccines. At all visits, review the patient’s immunization status, regardless of the reason for the visit. Maintain a comprehensive immunization record in the patient’s chart and update it regularly, as well as send the information to the immunization registry.

Follow the U.S. recommended immunization schedule

The Centers for Disease Control and Prevention recommends that adolescents receive several vaccines starting at 11–12 years of age, including Tdap, meningococcal ACWY vaccine, and the HPV series. Three doses of HPV are recommended over a 6-month period, and the second dose of meningococcal ACWY vaccine is given 16 years of age. Influenza vaccine is recommended annually. If your patient falls behind, vaccinate at the next opportunity or recall him or her for overdue vaccines.

Schedule vaccine-only quick visits

The National Vaccine Advisory Committee suggests vaccination-only visits, with staff members who are permitted under state law to assess the need for and provide vaccination services using standing orders. Offering such opportunities during regular office hours, or providing flexible hours in the evenings or on weekends, will help increase access to vaccines and help your practice run more efficiently.

Make vaccination education a priority, for parents as well as patients

Many parents are not aware that adolescents need a number of vaccinations. Others may question whether their children will benefit from the recommended immunizations. In addition to sharing information from trustworthy sources, providers can make themselves or designated staff members available to address individual concerns about vaccines and provide counseling and reassurance as needed.

Establish rapport with your adolescent patients

A nonjudgmental approach, a readiness to listen and answer questions, and an assurance of confidentiality can help adolescents feel comfortable discussing a wide range of issues, including vaccinations. In many cases, vaccinations will be part of a broader discussion of common clinical and psychosocial concerns of the adolescent years.

Create a culture that values well-adolescent care

Young children are expected to have regular health assessments that include immunization. The next logical step is to create the same set of high expectations for well-adolescent care. Every member of your staff should emphasize the importance of adolescent vaccination and help assure that all doses of recommended vaccines for adolescents are administered. You also can reinforce this message by displaying posters or other appropriate educational materials in your waiting area or exam rooms.

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