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

Special Immunization Section

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.

In standards published in Public Health Reports in late February, NVAC highlighted the critical role that all members of the immunization neighborhood have in improving vaccine coverage among American adults. The standards are supported by CDC and a number of provider organizations, including APhA.

NVAC, established in 1987, advises and makes recommendations to the Assistant Secretary of Health in the U.S. Department of Health & Human Services (HHS). The HHS Secretary has designated the Assistant Secretary as the Director of the National Vaccine Program.

Assess, administer, or refer

NVAC recommends that all health professionals incorporate the assessment of vaccine needs into their routine clinical practice and implement systems to aid in the identification of patients who need vaccines based on age, risk factors, and prior vaccination history. Some of these systems may include use of written vaccination assessment protocols or standing orders that are appropriate for the setting and patient type. NVAC recommends that assessments occur at all routine outpatient visits, as well as when treating hospitalized patients and residents of long-term care facilities. 

Once a vaccination need has been identified, immunizing health professionals are encouraged to strongly recommend any necessary vaccines to patients and administer them at the time of the visit. NVAC advises that patients be educated using understandable language, including that provided in Vaccine Information Statements when available. Key components of this education may include explaining the benefits of vaccination and the potential costs of getting the diseases they protect against, as well as addressing any patient questions or concerns.  

Professionals who do not stock and administer vaccines are encouraged to refer patients to other health professionals with vaccination capabilities. NVAC also encourages the establishment of patient referral relationships to minimize any potential barriers to immunization. Patients receiving referrals to other professionals should be given the complete contact information for the referred professional and a prescription (when necessary), and appropriate follow-up should occur at the next clinical encounter to ensure vaccines were administered. 

NVAC noted that vaccine uptake is much higher when the vaccine is recommended and administered to the patient at the same visit. For this reason, NVAC encourages all professionals who are capable of stocking vaccines to do so.

Education, documentation essential

The standards also highlight the need for professionals to be well educated on vaccine-related issues and up to date with their own vaccinations per health care personnel vaccine recommendations. Professional competencies identified by NVAC include knowledge of vaccine recommendations, vaccine administration, vaccine storage and handling, safety considerations, and appropriate documentation. The standards recommend that professional health care organizations, associations, and systems integrate information on immunizations into professional training and assist their members in remaining current by providing routine updates through communications or continuing education. NVAC also noted the role that public health departments have in educating patients and professionals on immunizations.   

Another key component of the updated standards is an emphasis on appropriate documentation in the era of electronic medical records (EMR) and state immunization registries. NVAC recommends that a record of receipt of vaccination be placed in the patient’s EMR and that information be placed in immunization information systems when available. In addition, primary care providers should be informed of any vaccines given to their patients by alternative providers, and all patients should receive a written or electronic record of administered vaccines. 

The ‘immunization neighborhood’ 

The new standards highlight the importance of collaboration between immunizing and nonimmunizing professionals and support the concept of an “immunization neighborhood.” This term, coined by APhA, involves collaboration, coordination, and communication among immunization stakeholders, with the goal of meeting the immunization needs of patients and protecting the community from vaccine-preventable diseases.

Pharmacists play a central role in establishing an immunization neighborhood by assessing the vaccination needs of all their patients, administering any necessary vaccines as allowed by state law, and appropriately documenting and following up with other health professionals to ensure continuity of care.