Facilitate Return for Vaccination

Evidence base

Provider office setting

• Distance to care and referrals outside of primary care are key barriers to accessing immunization services, particularly in rural areas.1
• An implementation study conducted in 2021 found the number of immunizations administered to pediatric patients doubled after the introduction of standing orders that allowed immunization at any visit.2
• In a 2023 study workflow changes successfully removed barriers to immunization for children with developmental disabilities or phobias.3

Birthing hospital setting

In birthing hospitals, this core strategy focuses on implementing processes to facilitate newborn immunizations prior to discharge from the birth hospitalization.

• Standing orders are an effective means of increasing immunization rates in the hospital setting.4
• One study found that implementing standardized orders in a birthing hospital increased hepatitis B birth dose coverage from 44% to 84%.5

Evidence-based best practices

Provider office setting

Scheduling and communication

• Use effective scheduling protocols to schedule the next appointment before the patient leaves the office, either in the exam room or during check-out.
• Use presumptive language when scheduling the next appointment.
• Build out clinic schedules into the future to prevent caregivers from needing to remember to call back once the schedule opens.
• Allow online self-scheduling tools for those who prefer contact-less options.
• Give caregivers a copy of their child's current immunization record and a list of future recommended vaccines with precise due dates.

Convenience and accessibility

• Screen for and offer immunizations at every visit regardless of the type of visit (e.g., well-child, sports physicals).
• Create standing orders for nurse-only appointments.
• Expand clinic hours to accommodate working families.
• Offer immunizations at satellite locations or community events for easy access.
• Offer low stimulus clinic environments, longer appointment times, or in-car immunizations for patients with special needs to reduce patient stress.

Birthing hospital setting

• Ensure infants are scheduled for their first well child visit prior to discharge.
• If the infant did not receive the perinatal Hep B birth dose or RSV immunization, implement a process to ensure the newborn's pediatrician is aware the newborn needs these immunizations during the first well child visit.
• Implement standing orders for administering the birth dose of Hep B within 24 hours of birth and RSV before hospital discharge, respectively, ensuring all eligible newborns are automatically offered the vaccine.

Strategy resources

Accommodate patients with special needs

• Vaccine Education Initiative (Autism Society of America)
• Guide to Accessible Vaccine Clinics (Autism Society of America)
• Quick Tips for Sensory-Friendly Vaccination Events (Autism Society of America)
• Vaccine Conversation Starters for Autistic Individuals and Providers (Autism Society of America)
• Improving the Vaccination Experience: Neurodiverse People at Any Age (Immunize.org)

Increase access to immunizations

• Guidance for Vaccination Clinics (CDC)

Standing orders

• Provider office
  • Using Standing Orders for Administering Vaccines: What You Should Know (Immunize.org)
  • Clinical Resources: Standing Orders Templates (Immunize.org)
  • Steps to Implementing Standing Orders for Immunization in Your Practice Setting (Immunize.org)
• Birthing hospitals
  • Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus Transmission (Immunize.org)
  • Standing Orders for Administering Nirsevimab RSV Preventive Antibody to Infants (Immunize.org)