How to Start an Office-based Immunization Program

Women are much more likely to receive immunizations following a recommendation and offer from their doctor. Setting up an office-based immunization program allows you to offer your patients, their families, and your community protection from diseases. For more information, read "Immunizations and Routine Obstetric-Gynecologic Care: A Guide for Providers and Patients." 

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
  • Ventilation
  • 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
  • Informational materials.
  • Adequate space for patients to sit or recline should be available.

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.

Depending on the size of the practice and services provided, many of the supplies necessary for the immunization program already may 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
  • Diphenhydramine
  • Ammonia Inhalant Capsules (for fainting)
  • Syringes for medication administration
  • Adult airways (small, medium, large)
  • Sphygmomanometer
  • Stethoscope
  • Adult size pocket mask with one way valve
  • Alcohol wipes
  • Tourniquet
  • Tongue depressors
  • Flashlight with extra batteries
  • Timing device

Electronic or paper documentation is an important part of establishing an immunization program. Standing orders allow a nurse or other approved practitioner to administer vaccines in absence of a physician. Additionally, a vaccine questionnaire should be used to assess the immunization status of patients and determine what vaccines may be needed based on age and circumstances (i.e. planning a pregnancy or international travel). ACOG's Vaccine Questionnaire can be found in Appendix C of Immunizations and Routine Gynecologic Care: A Guide for Providers and Patients

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 the section on Liability on this website for more information.

ACOG's Immunization resource is available for sale in the bookstore: Immunizations and Routine Gynecologic Care: A Guide for Providers and Patients.

Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization

The Advisory Committee on Immunization Practices (ACIP) makes recommendations for routine vaccination of adults in the United States. Standards for implementing the ACIP recommendations for adults were published by the National Vaccine Advisory Committee (NVAC) in 2003 and by the Infectious Diseases Society of America in 2009. In addition, NVAC published a report in 2012 outlining a pathway for improving adult immunization rates. While most of these documents included guidelines for immunization practice, recent changes in the practice climate for adult immunization necessitated an update of existing adult immunization standards. Some of these changes include expansion of vaccination services offered by pharmacists and other community immunization providers both during and since the 2009 H1N1 influenza pandemic; vaccination at the workplace; increased vaccination by providers who care for pregnant women; and changes in the health-care system, including the Affordable Care Act (ACA), which requires first-dollar coverage of ACIP-recommended vaccines for people with certain private insurance plans, or those who are beneficiaries of expanded Medicaid plans. 

This website is supported by an independent educational grant from Merck and an educational grant from Sanofi Pasteur U.S. 
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