Date of Award


Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Sheri Jacobson, PHD, RN

Second Advisor

Sarah Cartwright, DNP, RN-BC


Practice Problem: Low pneumococcal vaccine uptake among high-risk adults is partly due to underutilized or lack of nurse-driven vaccine protocols, limited understanding of vaccine intervals and indications by nurses, and lack of proper training. Currently, physician-driven orders are the only avenue for high-risk adults to obtain this vaccine in ambulatory sites.

PICOT: In adults 65 years or older within an ambulatory setting, does the use of an adult pneumococcal vaccine protocol, compared to a physician order (no vaccine protocol) impact the rate of vaccination over 2 months?

Evidence: Utilization of two or more interventions provided higher immunization rates. Interventions with stronger evidence rate include nurse-driven vaccine protocols, vaccine reminders, and use of electronic health system alerts. Review of programs and toolkits proved efficient interventions of vaccine programs based on CDC program evaluation framework.

Intervention: The program evaluation yielded best practices for adult pneumococcal vaccine compliance utilizing nurse-driven protocols based on CDC recommendations and a competency-based orientation toolkit to support staff members when working in ambulatory settings.

Outcome: A CBO toolkit was created to facilitate the ordering and administration of pneumococcal vaccines based on approved protocol to increase vaccine uptake. CBO toolkits offer nurses autonomy and increased competency with safe injection practices.

Conclusion: Adult vaccine programs with nurse-driven protocols in combination with other modalities, prove effective to increase pneumococcal vaccine rates among high-risk groups and expands access to preventive health services provided by nursing staff. A CBO toolkit increases competency of injection practices of nurses in ambulatory settings.


Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.