Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Katie Jacobs

Committee Member

Dr. Julie Ossege



According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study.


This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, 2017 to February 28, 2018. Participants for this study were taken from the list of all patients currently active at this clinic via the electronic medical record. This study was conducted in four phases, using the Plan Do Study Act (PDSA) improvement model as a guide. Focus groups were held with clinic staff to establish a process change for influenza vaccination. Chart audits were done monthly and changes were made based on feedback from clinic staff and vaccination rates.


Starting vaccination rates at the clinic were 0.65% in October 2017. The first full month of entire clinic compliance with the standardized process was February 1, 2018 to February 28, 2018, with vaccination rates of 30.42%. This was a 29.77% increase in vaccination rates during the study and a 5.2% increase from the 2016-2017 influenza vaccination rates of 25%.


Through a team based practice improvement process, overall vaccination rates increased at this clinic. MACRA reimbursement requirements were achieved at this clinic due to this vaccination increase. Creating a standardized screening and vaccination protocol was feasible and effective in increasing vaccination rates within this clinic.