1. Don’t Forget the HPV Vaccine!
A initiative to increase HPV vaccination immunization rates
Provider Practice Toolkit

2. Cape Atlantic Coalition for Health is a regional chronic disease prevention coalition funded by the New Jersey Department of Health, Office of Cancer
Control and Prevention. Our purpose is to reduce the state’s cancer burden and improve health outcomes for people with, or at risk for, cancer and
other chronic diseases in Atlantic and Cape May counties. For more information on Comprehensive Cancer Control visit www.njcancer.gov. Shore
Medical Center is lead agency for Atlantic and Cape May Counties.
Mission
The Cape Atlantic Coalition for Health is dedicated to improving health outcomes while
reducing the chronic disease burden for the Cape Atlantic Region by using
effective evidence based strategies and programs.
Goals
 Engage healthcare providers and the general public to partner on evidence/practice based
community-clinical interventions to reduce chronic disease.
 Implement effective policy, system and environmental changes to improve public health.
 Enact the New Jersey Comprehensive Cancer Control Plan in Atlantic and Cape May
County.
History
The coalitions are an initiative by the New Jersey Department of Health, Office of Cancer Control
and Prevention. The coalitions were developed in 2004 in each county after a needs assessment
was completed for each county. The county coalitions were charged with enacting the New Jersey
Comprehensive Cancer Control Plan at the local level and focused predominately on Cancer Pre-
vention and Early Detection initiatives. In 2012, the county coalitions were merged into regional
chronic disease coalitions. In the summer of 2012, Atlantic Healthy Living Coalition and Cape May
Chronic Illness Coalition merged together to form the Cape Atlantic Coalition for Health. There are
ten coalitions in New Jersey in which every county is represented. The focus continues on cancer
projects to reduce cancer burden, but also includes other chronic diseases and highlights healthy
lifestyle behaviors.

3. Don’t Forget the HPV Vaccine!
According to the American Cancer Society, HPV causes 70% of all cervical cancers
and precancers, as well as other cancers such as cancers of the anus, vulva, vagina,
and throat. Nationally every year, an estimated 26,000 cancers are
associated with HPV; about 17,000 in women and 9,000 in men.
Even despite these statistics, the use of HPV vaccine is limited and
immunizations are low in New Jersey. The goal of this project is to increase
healthcare provider recommendations for the HPV vaccine to increase HPV
immunization rates in our area. Recent studies have shown that a patient who
receives a provider recommendation is 4-5 times more likely to receive the
HPV vaccine.
Project
Cape Atlantic Coalition for Health’s HPV vaccination project includes two options.
You can choose the option that can work best for your practice.
Option 1:
 An educational in-service meeting which would include 20 minute lecture
and discussion about the importance of recommending the HPV vaccine to
parents from Cape Atlantic Coalition for Health staff.
 Display HPV vaccine related health education materials within your office.
Option 2:
 Implement an office policy to increase HPV immunization rates through
effective strategies focused on provider recommendations.
 Display health education materials such as posters, brochures, and fact sheets
within your office.
 Develop and implement an evaluation plan to determine the effectiveness of
your office policy.
 Includes educational in-service meeting from Option 1.

4. Incentives
 Possible stipend for your practice for
participating in the project (depends on scope
of involvement).
 An opportunity to focus on quality improvement
for your practice.
 Increase HPV vaccine immunization rates.
Strategies to Increase HPV Immunization Rates
 Implementing standing orders for HPV Vaccination.
 All pediatricians within the practice must follow the
AAP recommendations for the HPV vaccine and
strongly recommend HPV with usual adolescent/child
vaccines such as Tdap, and MCV4.
 Provider Prompts (in an EMR system or notes in charts).
 Educating eligible patient/parents.
 Patient Reminder-Recall.

5. Example of Office Policy (Standing Orders)
Waiting Area
 Place informational posters, fact sheets, or attractive
posters in the waiting room.
At Patient Check-in
1. As soon as patient arrives, the staff member will check the
immunization record to see if any vaccines are due and if
the patient has any contraindications to vaccination. Give
parents information about the HPV vaccine.
2. If the patient/parent declines HPV vaccination, the MA will
notify the physician and track the outcome.
3. If vaccine is due and patient/parent does not decline the
vaccination, the MA or RN on site will prepare it.
4. The MA will do the charting per routine.
Policy: Medical Assistants and Registered Nurses can work off a
standing order and administer the HPV vaccine for all adolescents
(age 11 & up). However, a Medical Assistant can only administer if
a RN or Physician is onsite.

6. 1. The MA will check everything with RN/Physician before
administering the vaccine (If the RN is not administering
it).
2. The MA or RN can administer the vaccination either
before the doctor visits or after the doctor leaves the
exam room.
During Visit
After Visit
1. The MA will schedule the patient for the 2nd dose in the
HPV vaccine series.
2. When the appointment for the second dose comes closer,
office can send reminder to patient using an EMR system
or through mail/telephone.

7. Example of Office Policy
(Strong Provider Recommendation)
Policy: All providers within the practice must follow the AAP
recommendations for the HPV vaccine and
strongly recommend for simultaneous Tdap, MCV4, and HPV
vaccinations in one visit.
At Patient Check-in
1. As soon as patient arrives, the *staff member* will check the
immunization record to see if any vaccines are due and if
there are any contraindications to vaccination. Give parents
information about HPV vaccine.
2. The MA or RN on site will prepare all three vaccinations: Tdap,
MCV 4, and HPV.
3. The MA will do the charting per routine.
 Place informational posters, fact sheets, or attractive
posters in the waiting room.
Waiting Area

8. During Visit
1. Patient/Parents can ask provider any questions
about the HPV vaccination.
2. Provider will recommend and order the first dose of
HPV vaccine whenever they order Tdap and MCV4
and will be prepared to explain if parents have
questions.
3. The RN or provider can administer the vaccination.
4. If parent refuses HPV vaccination, that will be
recorded in the patient chart by the MA or RN.
1. The MA will schedule the patient for the 2nd dose
in the HPV vaccine series.
2. When the appointment for the second dose
comes closer, office can send reminder to patient
using an EMR system or through mail/telephone.
After Visit

9. Example of Office Policy (Provider Prompts)
Policy: *Assigned Vaccine Coordinator* (Can be MA or RN)
will review charts for adolescents at all visits to see if they are
due for an HPV vaccine and put a prompt in the EMR or note
in chart. In addition, will give provider the VIS form to remind
him/her to order the vaccine.
At Patient Check-in
1. As soon as patient arrives, the *staff member* will check
the immunization record to see if any vaccines are due
and if there are any contraindications to vaccination.
Give parents information about HPV vaccine.
2. The MA or RN will do the charting per routine.
 Place informational posters, fact sheets, or
attractive posters in the waiting room.
Waiting Area

10. During Visit
1. Viewing the prompt, the provider can strongly recommend
the vaccination to the patient/parent.
2. Patient/Parents can ask provider any questions about HPV
vaccine.
3. If patient/parent agrees, the RN or provider can administer
the vaccination.
4. If parent refuses HPV vaccine, that will be recorded in the
patient chart or EMR system by the MA or RN.
1. The MA will schedule the patient for the 2nd dose
in the HPV vaccine series.
2. When the appointment for the second dose
comes closer, office can send reminder to patient
using an EMR system or through mail/telephone.
After Visit

11. Example of Office Policy (Education)
Policy: At every wellness visit, the assigned staff member will
give eligible patients and their parents information about the
HPV Vaccine. The provider or nurse can educate the parents
about the vaccination and answer any questions.
At Patient Check-in
1. As soon as patient arrives, the *staff member* will check
the immunization record to see if any vaccines are due
and if they are eligible for the HPV vaccination.
2. Give parents information about HPV vaccination.
 Place informational posters, fact sheets, or
attractive posters in the waiting room.
Waiting Area

12. During Visit
1. Viewing the prompt, the provider can strongly recommend
the vaccination to the patient/parent.
2. Patient/Parents can ask provider any questions about HPV
vaccination.
3. If patient/parent agrees, the RN or provider can administer
the vaccination or order the vaccine for next wellness visit.
4. If parent refuses HPV vaccination, that will be recorded in
the patient chart or EMR system by the MA or RN.
1. The MA will schedule the patient for the 2nd dose in the
HPV vaccine series if the patient received the
vaccination during that visit.
OR
The MA will schedule the patient for 1st dose in the
HPV vaccine series during next visit.
2. When the appointment for the first or second dose
comes closer, office can send reminder to patient using an
EMR system or through mail/telephone.
After Visit

13. Evaluating your Office Policy
Evaluation is an essential to determine the effectiveness. Here
are some ideas that can help you evaluate your office policy
to see if it is working to increase HPV immunizations rates
within your practice:
 Using your practice’s billing system
1. Create a spreadsheet of all the patients with a
birthday in the correct range who have generated
any billing event in the past 24 months. That list will
give a number to each patient (0-xxx).
2. Then, a staff member can generate a list of 20
random numbers from 0 to xxx.
3. The staff member will check the charge of each of
the 20 patients corresponding to the numbers and
tally if the patient received 0, 1-2 or > or = 3 doses of
the HPV vaccine.
 Keeping track of HPV Vaccine Inventory
1. Use HPV Vaccine inventory data from previous years
as baseline data.
2. Keep track of HPV vaccine inventory starting when
you implemented your office policy.
 Using an EMR system to track HPV vaccinations
 Track HPV vaccination refusals
 Tracking number of eligible patients educated

14. Provider Tools & Resources
American Academy of Pediatrics, HPV Champion Toolkit
The American Academy of Pediatrics established a toolkit to help
increase HPV Vaccination immunization rates within
pediatrician offices. This toolkit provides resources and guidance
to increase HPV immunization rates and to improved quality within
your practice.
https://www.aap.org/en-us/advocacy-and-policy/aap-health-
initiatives/Pages/HPV-Champion-Toolkit.aspx
Immunization Action Coalition, Standing orders for administering
HPV vaccine to children and teens
Example of standing orders for HPV vaccine administration where
eligible healthcare professionals (Nurses, MAs, etc.) may vaccinate
children and adolescents that eligible for the vaccine.
Immunize.org/catg.d/p3090.pdf (Children and Teens)
Immunize.org/catg.d/p3091.pdf (Adults)
Health IT.gov, Patient Reminders through EMR system
Instructions on how to EMR systems to send patient reminders about
preventative and follow-up care
http://www.healthit.gov/providers-professionals/achieve-
meaningful-use/menu-measures/patient-reminders

15. Provider Tools & Resources
Tips and Time Savers for Health Professional, Center for Disease
Control
This resource provides tips for talking with parents who may have
questions about the HPV vaccine based on research that was
done by the CDC.
http://www.cdc.gov/vaccines/who/teens/for-hcp-tipsheet-
hpv.pdf
Minnesota Department of Health
HPV Vaccine for Healthcare Providers
Minnesota Department of Health created a series of videos related
to HPV vaccination to help providers learn how to effectively
communicate with the patient/parents about the importance of
the vaccine and why they should get vaccinated.
http://www.health.state.mn.us/divs/idepc/immunize/hcp/adol/
hpvvideos.html
Center for Disease Control, HPV Vaccine resources for
Healthcare Professionals
CDC has great resources and information about the
HPV Vaccine for healthcare providers. There are tools for prac-
tice and handouts to give to your patients. In addition, there are
information videos and CE or CME opportunities for providers.
http://www.cdc.gov/vaccines/who/teens/for-hcp/hpv-

16. Provider Tools & Resources
Academy of Pediatrics: Reminder/Recall Systems
for Immunizations
This fact sheet provides ideas for reminder/recall systems for
immunizations.
https://www2.aap.org/immunization/pediatricians/pdf/
ReminderRecall.pdf

17. References
Academy of Pediatrics (2015). HPV Toolkit: Making a change in
your office. Retrieved from: http://www.cancer.org/acs/
groups/cid/documents/webcontent/002780-pdf.pdf
American Cancer Society (2015) HPV Vaccines. Retrieved from:
http://www.cancer.org/acs/groups/cid/documents/web
content/002780-pdf.pdf