PROVIDER SELF-ASSESSMENT OF STRENGTH OF IMMUNIZATION RECOMMENDATIONS

The NVAC Adult Immunization Standards call on all providers of healthcare to adult patients to assess, recommend, administer/refer and document immunizations. A strong recommendation from a healthcare provider can influence the outcome resulting in a patient being administered a needed vaccine. The elements leading to a strong recommendation are listed below. This self-assessment is intended as a guide to providers to determine their current activities and approaches and identify areas for additional focus that will lead to consistency and strengthening of immunization recommendations.

Practice Name

State (where practice located)

Email Address

Practice-site focused

	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Educational information / tools on immunizations provided to patients in waiting areas and other means of patient communications	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Provide immunization education tools / surveys at check-in for patients to review/complete while waiting	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Have immunization education messages in areas where the vaccine is administered (posters, brochures, video, etc.)	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Provide immunization messages thru electronic patient portals and/or appointment reminders	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Provide patient access to the immunization records	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable

Patient-Practitioner Interaction

	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
You and your staff clearly convey your strong vaccine recommendation (“I recommend you receive vaccine X because…,” or “Vaccine X is recommended for you because…” vs saying “Vaccine X is an option if you want it.” )	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
SHARE the tailored reasons why the recommended vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
HIGHTLIGHT positive experiences with vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in vaccination.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Share your own immunization status with the patient (show how you walk the walk)	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
ADDRESS patient questions and any concerns about the vaccine, including side effects, safety, and vaccine effectiveness in plain and understandable language	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
REMIND patients that vaccines protect them and their loved ones from many common and serious diseases	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
EXPLAIN the potential costs of getting the disease, including serious health effects, time lost (such as missing work or family obligations), and financial costs.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Utilize open-ended questions to assess the patient’s understanding of the information provided and/or identify beliefs / concerns	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Offer to administer the vaccine at the visit in which you make the recommendation.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
If you don’t stock the vaccine, ensure the patient has clear directions about which vaccine to get and where to get it.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Encourage patients to carry immunization record cards/ access to electronic immunization records	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Immunization information and recommendation delivered in language and way patient can understand (language, culture, other)	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
If referring patient to another provider to receive the vaccination you provide a referral order / communication to the patient and/or the provider and request to receive information back when the patient gets vaccinated.	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable

Patient Action

	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable
Patients take action based on your recommendation (vaccinated by you or someone else)	No or rarely	To some extent	Somewhat consistently	Consistently	Not applicable