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Table 1 Intervention strategies used to increase adult vaccination rates from the 4 pillars™ practice transformation program

From: Using the 4 pillars™ practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial

Pillar 1 Convenient vaccination services
 • Use every patient visit type as an opportunity to vaccinate.
 • Offer open access/walk-in vaccination during office hours.
 • Hold express vaccination clinics outside normal office hours where only influenza vaccine is offered and systems for check-in, screening, and record keeping are streamlined.
 • Create a dedicated vaccination station.
 • Extend the influenza vaccination season by vaccinating as soon as supplies arrive and continuing to vaccinate as long as flu is circulating in the community.
Pillar 2 Communication with patients about the importance of vaccination and the availability of vaccines
 • Train staff to discuss influenza vaccine during routine processes such as vital signs
 • Discuss the serious nature of influenza
 • Promote vaccination of staff to set a good example
 • Record telephone on-hold messages that advertise vaccine availability or promote vaccination.
 • Use posters/fliers/electronic message board/website postings/social media promoting vaccination
 • Conduct outreach by email, phone, text, mail, health portal, etc. that vaccines are due and/or available
Pillar 3 Enhanced office systems to facilitate adult vaccination
 • Assess vaccination eligibility for every scheduled patient at the beginning of the day and discuss in daily huddles
 • Assess immunizations as part of vital signs upon rooming patients and record outside vaccinations in EMR
 • Incorporate EMR prompts for vaccination into the workflow
 • Incorporate standing order programs (SOP) for vaccination by nurses and/or medical assistants into the workflow
 • Ensure sufficient vaccine inventory to handle increased immunizations
 • Promote simultaneous vaccination (e.g., offer other vaccines at the time of influenza vaccination)
Pillar 4 Motivation through an office immunization champion
 • Create a chart to track progress. Set an improvement goal and regularly track progress (e.g., daily or weekly). Post the graph of your progress in a prominent location and update it regularly.
 • Provide ongoing feedback to staff on vaccination progress using email, posted notices, making announcements, or using a combination of these. Encourage, nudge, and cheer as needed to keep up the momentum.
 • Report upon progress at staff or huddle meetings. Facilitate discussion at these meetings to identify which pillar activities are working, which are not working and why, and to identify changes that need to be made.
 • Create a competitive challenge among your staff for the most vaccinations given.
 • Provide rewards for successful results to create a fun-spirited environment that promotes vaccination across the practice. Ideas include: reward for highest vaccinator, team competitions, vaccination goal poster contest, etc.