Influenza Vaccine Preparation Checklist

Clinical Preparedness

Strain and Formulation Review

• Review CDC Advisory Committee on Immunization Practices (ACIP) and World Health Organization recommendations for the current season’s circulating strains.
• Identify all available formulations: standard-dose trivalent inactivated influenza vaccine (IIV3); HD-IIV3 (Fluzone HD; Sanofi); aIIV3 (Fluad; CSL Seqirus); recombinant influenza vaccine, trivalent (Flublok; Sanofi); and trivalent live attenuated influenza vaccine (LAIV3, FluMist; MedImmune, LLC).
• Note any new ACIP preferential recommendations by age group (eg, high-dose or adjuvanted preferred for individuals 65 years and older).
• Review FDA-approved product changes and updated package inserts for this season.

Screening and Counseling

• Update screening questionnaires to reflect current contraindications and precautions.
• Confirm coadministration protocols.
• Refresh patient counseling points: timing (by the end of October), annual need, and expected effectiveness.

Staff Competency

• Verify that all vaccinating staff hold current, state-valid immunization certification.
• Conduct an annual refresher on injection technique, LAIV nasal administration, and anaphylaxis response.
• Confirm basic life support/cardiopulmonary resuscitation certification is current, and review Vaccine Adverse Event Reporting System reporting responsibilities.

Ordering & Procurement

• Analyze data from the prior 2 seasons to forecast demand by formulation and patient demographics.
• Contact wholesalers and manufacturers to secure allocation.
• Confirm ordering windows and deadlines, and identify a backup supplier in case of shortage or recall.
• Order all required formulations, including pediatric presentations. Document purchase orders with expected delivery dates.
• Stock ancillary supplies: 22g-25g needles (1”-1.5”), syringes, alcohol swabs, and bandages. Add a 10% to 15% buffer over prior-season quantities.
• Obtain current-edition Vaccine Information Statements or confirm your electronic health record (EHR) delivers the current version at the point of care.

Storage and Cold Chain

• Inspect and service refrigeration units. Confirm the temperature is maintained at 2 °C to 8 °C using a calibrated data logger.
• Test continuous monitoring alarms and verify that after-hours alert contacts are up to date.
• Confirm backup power covers refrigeration, and document emergency transfer protocol to a partner pharmacy.
• Designate a trained staff member to receive shipments: Check temperature indicators, vial integrity, and documentation before accepting.
• Log lot numbers, expiration dates, and quantities for every delivery, and implement first-in, first-out rotation.
• Review the vaccine temperature excursion standard of practice. Segregate but do not discard the affected product before contacting the manufacturer or state health department.
• For LAIV, store refrigerated, not frozen. Do not refreeze once removed from cold storage.

Regulatory, Billing, and Documentation

• Confirm immunization scope of practice for pharmacists and technicians under current state law.
• Renew standing orders or collaborative practice agreements before the season begins.
• Verify malpractice coverage includes vaccine administration; confirm applicable Public Readiness and Emergency Preparedness Act protections.
• Update current procedural terminology and vaccine-administered codes in your practice management system/EHR for all flu products. Codes change annually.
• Confirm Medicare Part B billing (no deductible/co-pay for beneficiaries); verify Medicaid and commercial coverage for each formulation.
• Update self-pay pricing; confirm 340B segregation and documentation if applicable.
• Test EHR workflow end-to-end: lot number capture, consent documentation (include the vaccine information statement publication date), and state immunization information system transmission.

Operations and Patient Experience

• Streamline vaccination workflow, including a dedicated queue, injection station, and 15-minute postvaccination observation seating.
• Set staffing plan for peak demand (September-November) and identify all certified immunizers on staff.
• Update the pharmacy’s website, Google Business Profile, and social media with formulations offered, hours, and walk-in/appointment policy.
• Activate patient outreach with automated reminders for high-risk groups (adults 65 years or older, pregnant patients, children aged 6 months to 5 years, and immunocompromised).
• Pursue on-site clinic opportunities with employers, senior centers, and schools; begin outreach by August.
• Confirm epinephrine auto-injectors (≥ 2, nonexpired) are stocked at every vaccination station. Post emergency protocol and contacts.
• Review sharps/needlestick injury protocol, and ensure sharps containers are at all points of care.