Discussion among the Vaccine SHAPE (Storage, Handling, Administration, Preparation Experts) Working Group, as well as with state and local vaccine experts, point to one approach to provide continuous process improvement to vaccine delivery in any practice: Simplifying the complexity at each step in the process.

Central to this concept are approaches that improve both human reliability, such as ensuring proper knowledge and training for all vaccine providers, and system reliability through technological improvements. 

The introduction of “smart” refrigerators that provide automated inventory counts, expiration-date tracking, and real-time remote temperature monitoring is one current example. Such equipment is not without cost, but we can look toward less resource-intensive improvements. 

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For example, use of inexpensive vaccine-vial monitors to confirm temperature stability and increase confidence in the vaccine dose being administered would be a clear low-cost improvement. 

Use of ready-to-administer manufacturer prefilled syringes that are typically at price parity on vaccine purchase schedules can eliminate multiple opportunities for unintentional error. 

Considering each step in vaccine delivery and evaluating what works best in practice to eliminate or lessen the opportunities for error ensures optimal vaccine delivery. (191-5)

L.J. Tan, MS, PhD, is a chief strategy officer for the Immunization Action Coalition (immunize.org) and first author of the group’s recent report, “From Refrigerator to Arm: Issues in Vaccine Delivery” (Vaccine. 2014;32[21]:2389-2393). 

The Clinical Advisor asked our Advisor Forum consultants what sorts of clinical questions they have fielded from their colleagues lately and what puzzling cases they have encountered themselves. We invite you to participate. If you have a clinical pearl or clinical question, please submit it here.