Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE

Background: Project VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow. Objective: The objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members’ perceptions of work system factors that influenced the implementation of key intervention features. Methods: Pharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems. Results: A total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage. Conclusions: Several key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy–based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.