Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Jean Dols


Mitchell Finnie


The purpose of this evidenced-based quality improvement project is to implement processes to facilitate providers’ adherence to the American Diabetes Association (2017), American Association of Clinical Endocrinologist (2015), and American College of Endocrinology (2015) immunization guidelines for adults with type II diabetes. Presently, diabetes is the 7th leading cause of death in the United States contributing to serious complications throughout the body as a result of poor glucose control. Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. A protocol was created using The Four Pillars Transformation Program ™ to align provider practices at a family practice clinic with recommended guidelines. Interventions aimed at improving recommended vaccination rates in adults with type II diabetes mellitus include standing orders for all immunizations, a vaccine clinic that operates simultaneously during office hours, vaccine needs screening, patient education, flyers, electronic medical record alerts, an appointed immunization champion, and quality improvement meetings. At project completion 62% of eligible patients had been screened for vaccine need and 62% received education. Ten weeks post project implementation, 64% of the eligible patients had been vaccinated with pneumococcal polysaccharide vaccine 23, 86% pneumococcal conjugate vaccine, 89% tetanus, and 54% herpes zoster. Thirty-seven out of 49 (76%) eligible patients who received education received all recommended vaccines indicating a need for continued work on staff and patient education that will facilitate patient consent for recommended vaccines.