ACOG recommendations on immunization integration in OB/GYN practices

Women’s health practitioners should offer vaccinations for a wide range of common, preventable diseases.
Women’s health practitioners should offer vaccinations for a wide range of common, preventable diseases.

As vaccination rates fall below national goals, women's health practitioners should provide all patients with accurate information and advice on appropriate immunization practices.

The American College of Obstetricians and Gynecologists (ACOG) recommends that all obstetrician-gynecologists discuss vaccines and vaccination practices with their patients. “Immunization against vaccine-preventable diseases is an essential component of women's primary and preventive health care,” the committee wrote. “Obstetrician-gynecologists can play a major role in reducing morbidity and mortality from a range of vaccine-preventable diseases.”

In addition to the recommendations listed below, the College has developed a web resource, Immunization for Women (http://www.immunizationforwomen.org/), to equip women's health practitioners to become routine administrators of common vaccines.

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The ACOG vaccination recommendations are as follows:

Obstetrician-gynecologists should strongly recommend indicated immunizations to each patient. Studies have shown that a recommendation from an obstetrician-gynecologist or related healthcare provider is a strong influence on patient acceptance. Use evidence-based medicine to allow patients to make informed decisions, and share specific reasons why immunization can be beneficial to both the patient and her family.

If a patient declines an immunization, both the discussion and decision should be documented. Ask the patient about her reasons for declining, and reopen the discussion at the patient's next office visit.

Designate an office immunization coordinator who orders vaccines, receives vaccine deliveries, and ensures proper vaccine storage. Educate office staff about the recommendations, safety, and efficacy of vaccinations; uncertainty expressed by staff members may have a detrimental effect on a patient's willingness to be immunized.

Use either paper or electronic prompts to remind clinicians and staff which patients need to be immunized.  Many electronic medical record systems include such prompts.

If permitted under state law, institute standing orders for indicated immunizations. Standing orders allow immunization administration to appropriate patients without an individual physician order. Clinicians should familiarize themselves with local statutory requirements surrounding these protocols.

Document that each patient has been educated regarded recommended immunizations and note whether the patient has accepted or declined the immunization, or received it at an outside facility. Complete this documentation in both the patient's chart and the state immunization registry.

Federal law mandates that all clinicians who administer vaccines must give patients, their parents, or their legal guardians a vaccine information statement – used to educate patients – before each vaccine dose is administered.

While lack of reimbursement can be perceived as a barrier for clinicians who wish to include immunization services in their practices, proper documentation and coding removes this barrier. Current Procedural Terminology (CPT) guidelines indicate that vaccinations should be reported separately from standard wellness visits.

More information, including patient consent requirements, state registry information, and standing immunization orders, is available at www.acog.org.

Reference

  1. Eckert LO, Beigi R, Tucker JM, Minkoff H. Integrating immunizations into practice. Committee Opinion No. 661. Washington, DC: American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127:e104-107. 
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