Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Diane Lavin


Pronounced disparities in adult immunizations exist across the country. In homeless adults over 50 years of age with chronic diseases, coverage rates for influenza and pneumococcal vaccinations falls at 30% as compared to the 60% coverage rate found in the general public. Hepatitis B immunization rates are also significantly lower in the elderly homeless population. Increased prevalence of chronic diseases in the elderly homeless shelter residents’ increase their risk for severe complications following influenza, hepatitis B and meningococcal infections. To prevent disease epidemics and further disability in the homeless population, the need for appropriate and timely vaccinations is critical. Attitudes and beliefs towards vaccinations, distrust of healthcare providers and limited access to healthcare are significant factors for low immunization rates in the homeless population. Alcohol and substance use, mental illness and multiple chronic diseases exacerbated by congregated living conditions are risk factors for communicable diseases, which are preventable when adequate surveillance and immunization strategies are implemented. The purpose of this quality improvement project is to increase vaccination rates among high-risk elderly homeless patients in a primary care clinic. Interventions included are the implementation of immunization standing orders and client reminder/recall cards. Improvement was evaluated by comparing pre- and post- intervention immunization rates in patient population. The effectiveness of reminder cards was measured by increase in patient appointments. It is recommended that healthcare providers treating homeless patients utilize clinical practice guidelines for planning and evaluating immunization protocols and most importantly, immunize these patients at every opportunity.