Table 4.

Kaiser Permanente Northwest regional strategies for improving influenza vaccination coverage during pregnancy

Date implemented	Description of strategy
1997–1998	Influenza immunization information was added as a standard “trailer” on after-visit summaries. Summaries are printed directly from the EMR at the end of ambulatory care visits.
June 2008	Department of Obstetrics and Gynecology implemented a clinician checklist with reminder to recommend vaccination to pregnant women during influenza season (defined as November 1 to March 31).
March 2009	Influenza vaccination became a “hard stop” in all inpatient admission order sets. A hard stop means the clinician must order influenza vaccination, note that the patient already received the vaccine, or provide a reason for not ordering the vaccine.
March 2010	Implementation of a set of orders in the EMR for clinicians to use at the “New OB” (first prenatal) visit, including an order for seasonal influenza vaccination.
May 2011	Implementation of a provider tool in the EMR flagging pregnant women who have not yet received influenza vaccination.

^aEMR = electronic medical record.