Systematic Workflow Changes Can Improve Pneumococcal Vaccine Rates

Through targeted, multidisciplinary interventions, a quality improvement initiative shows potential in boosting pneumococcal vaccination rates by standardizing assessments and delivery in routine clinical workflows. Due to the persistent gaps in preventive care for pneumococcal diseases, researchers of a study published in BMJ Open Quality believe the standardized approach can adapt within additional clinics and practices.¹

“Strengthening vaccination against pneumococcal disease, especially in high-risk populations, is critical to improving patient outcomes, reducing preventable diseases, and minimizing both clinical and public health risks,” wrote authors of the study. “Streptococcus pneumoniae is responsible for invasive diseases such as bacteremia and meningitis, with case fatality rates ranging from 40%-60% and 8%-22% respectively.”

The initiative, which took place at the Carle Foundation Hospital Internal Medicine Residency Clinic in Illinois, utilized Plan-Do-Study-Act (PDSA) cycles to address vaccination rates that were lower than national averages. To overcome barriers like staffing instability and competing clinical priorities, the team implemented system-level changes such as certified medical assistant-led pre-queuing of vaccine orders and structured reminders during morning huddles.¹

READ MORE: Pneumococcal Disease Significantly Reduces Health-Related Quality of Life

While the baseline vaccination rate for adults aged 50 and older was initially 39.9% following an expansion in eligibility guidelines, the standardized workflow helped increase this rate to 44.1% by the end of the intervention. Researchers concluded that embedding these efforts into routine operations reduces the dependence on individual clinician motivation and increases the likelihood of long-term sustainability.

The Pharmacist’s Role in Promoting Pneumococcal Immunization

“Pharmacists are kind of the center of a lot of the vaccinations in the country,” Megan Smith, PharmD, clinical pharmacist and health coach with Food City, told Drug Topics®. “We obviously have done so many flu and COVID vaccines over the past years and really increased that capacity, but the pneumococcal vaccine’s another one that we’re seeing more and more every day.”

For community pharmacists, these findings provide a vital template for action, as pharmacists are uniquely positioned to increase vaccination uptake due to their accessibility. Approximately 90% of Americans live within 5 miles of a pharmacy, and patients visit their local pharmacist on average twice as often as they do their physician, according to a study published in Vaccine.²

Despite this proximity, community pharmacists often encounter significant barriers, including difficulty determining patient eligibility and a lack of staff confidence regarding new services.

How Workflow Changes Can Improve Vaccination Rates

A cross-sectional survey of pharmacists revealed that many correctly identified vaccination recommendations in only a small fraction of cases, highlighting a critical knowledge gap that systematic workflow support could fill. Addressing these gaps requires more than education; it necessitates a structured change management process that focuses on the people, practices, and processes within the pharmacy.^2,3

According to Pfizer, effective workflow change often relies on the presence of a “pharmacy champion” who can coordinate project goals and bridge the gap between clinical needs and administrative support. The implementation of tools like reminder-recall systems, which have been shown to increase immunization rates by up to 20%, can be a cornerstone of this effort.³

Furthermore, electronic health record optimizations and automated best practice alerts have been identified as the single most influential factor in some settings, improving adult pneumococcal vaccination rates by as much as 31%. Using daily huddle reports to identify patients with care gaps and ensuring that vaccines are consistently in stock are practical steps that help normalize vaccine discussions as part of routine care.^1,3

The urgency for these improvements is supported by the massive public health burden of vaccine-preventable diseases, which cause an estimated 40,000 to 50,000 adult deaths in the US annually. Pneumococcal vaccination is not only a clinical priority but an economic one, with some analyses suggesting adult vaccines can yield returns of up to 19-fold relative to initial investment, as stated in Infectious Diseases & Clinical Microbiology.⁴

The CDC currently recommends pneumococcal vaccination for all adults aged 50 years or older, as well as younger adults with underlying risk factors such as chronic heart disease, diabetes, or smoking. While various vaccines like PCV15, PCV20, and PCV21 are available, the primary challenge remains ensuring they reach eligible populations.^4,5

By adopting a standardized approach to assessment and delivery, health care providers and pharmacists can work together to close the gaps in preventive care and improve outcomes for high-risk adults.^1,4

“I think the most important thing is, if you’re in doubt, whether you are eligible for it or not, go talk to your pharmacist about it,” concluded Smith. “They’re there to answer any questions you have and help you feel at ease and make the right decision for you. Don’t be afraid to ask; it could protect your life.”

READ MORE: Pneumococcal Resource Center

REFERENCES

1. Bista R, Ceniceros AG, Alli A. Improving pneumococcal vaccination uptake in a residency clinic: a case-inspired QI initiative aligned with updated CDC guidelines. BMJ Open Qual. 2026;15(2):e003878. https://doi.org/10.1136/bmjoq-2025-003878

2. Davies A, Schreiber D, Carey C, et al. Community pharmacists’ pneumococcal vaccine knowledge and perceived barriers to vaccination. Vaccine. 2025;53:126930. https://doi.org/10.1016/j.vaccine.2025.126930

3. Facilitating successful immunization workflow change at your organization. Pfizer. January 2020. Accessed May 21, 2026. https://www.vahealthinnovation.org/wp-content/uploads/2020/05/Facilitating-Successful-Immunization-Workflow-Change-at-Your-Organization-1.pdf

4. Durusu Tanrıöver M, Adaş M, Çiçekçioğlu H, et al. Burden of pneumococcal disease and adult vaccination landscape: an overview with data and policy insights from Türkiye. Infect Dis Clin Microbiol. 2025 Dec 15;7(4):337-349. doi: 10.36519/idcm.2025.757.

5. Pneumococcal vaccination. CDC. February 25, 2026. Accessed May 21, 2026. https://www.cdc.gov/pneumococcal/vaccines/index.html