CDC | NCIRD Workflow Determination Tool for Vaccine Administration 10

LESSONS LEARNED ON WORKFLOW 

FROM SCALABILITY PILOT 

Vaccine 2D Barcode Scanning 

Implementation Toolkit

National Center for Immunization and Respiratory Diseases (NCIRD)

Centers for Disease Control and Prevention (CDC)
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 1

2D Vaccine Barcode Scalability Pilot 

In 2016 to 2017, CDC conducted a pilot that assessed the impact and scalability of 

scanning 2D barcoded vaccines in a large health system. This project investigated the 

information technology needs and clinical workflow practice adjustments when 

implementing 2D barcode scanning of vaccine unit of use (UoU) products in health 

care practices. Additional considerations included an evaluation of staff adherence to 

vaccine 2D barcode scanning, the identification of workflow processes used for scanning 

across different health care practices, recognition of challenges experienced, and an 

assessment of the institutional impact of scanning.

Sutter Health, “a family of doctors and hospitals serving more than 100 communities,” 

and consisting of different health care practice settings (pediatric, family medicine, 

internal medicine, and vaccine clinics), was selected to participate based on the 

recruitment criteria. Vaccine 2D barcode scanning was implemented at 27 sites in the 

Sutter Health Network.

The following three pages document lessons learned from the pilot 

regarding workflow: 

y 2D Barcode Scanner Locations and Common Challenges

y Common Protocol Breaches due to an Inconvenient Workflow

y Case Studies

For more information, see the Findings Report: 2D Vaccine Barcode 

Scanning Pilot.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 2

2D Barcode Scanner Locations and Common Challenges 

2D barcode scanner locations at pilot sites were arranged in one of three setups: 

1. Single location: Individual desk, shared desk, or refrigerator/draw/prep.

2. Multiple location: Refrigerator/draw/prep and other location used equally.

3. Primary and backup: Refrigerator/draw/prep as primary, with backup option.

Pilot findings indicated that, in aggregate, 

scanners at more than one location 

(setups 2 and 3) had higher scanning 

rates than at a single location (setup 1). 

The refrigerator/draw/prep area paired 

with another location (used equally or 

as primary with backup) had the highest 

scanning rates. The refrigerator/draw/prep 

area as the single scanner location had the 

lowest scanning rates.

However, scanning rates (starting in week 

seven, when onsite observations took place) for all pilot sites show variation among all scanner 

setup types for the remaining pilot period, indicating no one setup type is ideal.

Pilot participants identified challenges experienced through multiple data collection methods. 

Several themes emerged, including challenges with scanner location, low engagement, and confusion 

regarding scanning protocol. Many of these issues can be anticipated, and prevented, through early 

communication with staff, increased efforts toward buy-in, and clearly understood training. 

Challenge Type Challenge

Data Source(s) in Which Challenge was Identified1

User Survey Group Discussions

Ongoing 

Observations/

Challenge Log

Scanner 

Location/

Issues

Location of scanner/setup 

did not work

Needing additional 

scanners

Low 

Engagement

Limited buy-in and 

understanding of scanning 

importance

Unclear on 

Scanning 

Protocol

Workarounds developed 

that do not align to 

scanning protocol (e.g., 

entering data in one 

step before or after 

administering vaccine)

Unsure if staff is scanning

1

Evanson, H. V., Huddleston Reed, J., Cox, R. “Improving Staff Experience with Vaccine Data Entry with 2D Barcode Scanning.” 

https://journals.lww.com/jncqjournal/Abstract/9000/Improving_Staff_Experience_With_Vaccine_Data_Entry.99369.aspx.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 3

Common Protocol Breaches due to an Inconvenient Workflow 

An inconvenient workflow can deter health care providers from practicing vaccine 2D barcode 

scanning. In the 2016 to 2017 pilot, two common workarounds to inconveniences were 

identified, which can both provide potential for error.

A convenient scanner location and carefully planned workflow can encourage health care 

providers to scan prior to administration. A clear protocol that includes scanning as a 

mandatory step can also help avoid the potential for error.

Additionally, it is important to remind all staff that, to fully realize safety benefits of scanning, 

vaccines should be scanned prior to administration.

Workaround to 

Inconvenience

Potential for Error

Health care providers entered 

data not yet confirmed prior to 

administration.

Certain data fields, such as completion of the vaccination 

and site of injection, cannot be confirmed until after vaccine 

administration is complete. Entering this data prior to 

administration can lead to incorrect records. For example, 

the patient may request a different arm than the clinician 

assumed in the record. 

Health care providers waited until 

after administration to scan, when 

all data (e.g., site of injection) was 

available for entry.

Scanning after administration does not take advantage of 

safety measures, including alerts to confirm that the scanned 

vaccine matches the vaccine order, if the vaccine is expired, or 

if the patient has already received the vaccine.

“It saves time, ensures 

accurate and consistent 

data entry, and provides an 

extra safety step prior to 

administration.”

—Survey respondent

“Provides an additional 

safety check before vaccine 

administration.”

—Survey respondent

During the pilot, one medical assistant defied 

protocol by scanning the vaccine after 

administration, and therefore experienced an 

immunization error. Upon scanning the vaccine, 

the EMR alert displayed “vaccine not ordered” 

because they had prepared—and administered—

Hep B instead of Hep A. If the medical assistant had 

scanned the vaccine prior to administration, the 

immunization error could have been prevented. 
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 4

Case Studies 

No “one-size-fits-all” workflow

One site initiated the pilot period with 2D barcode scanners placed in the patient rooms. The 

site then experienced a sharp decline in scanner use when the scanner was moved to another 

location, and this use remained low to the end of the pilot. While overall findings showed that 

scanners located in the refrigerator/draw/prep area paired with another location (used equally 

or as the primary with a backup) had highest scanning rates, in this case the site had the 

greatest success when the scanners were placed in patient rooms. The experience at this site 

demonstrates that there is no “one-size-fits-all” workflow.

Formalize protocols for all stakeholders

Discussions with staff and leaders at pilot sites identified the ways they had improved their 

own scanning rates. These ways can help others scan more consistently, including by, for 

example:

y Formalizing the protocol of scanning within the workflow.

y Making scanning mandatory and communicating this from the start.

y Adding a step to the vaccine verification process to ensure vaccines are scanned prior to 

vaccine administration.

y Having specific staff do all tray verifications to add consistency and accountability 

(if applicable).

To aid in scanning efficiency, protocols may be developed for physicians too. For example, if 

a physician orders a vaccine while still in the patient room, then the health care provider can 

utilize that time to scan, verify, and prepare the vaccine, and alert the physician if necessary.

“When the scanner was in the room, it was useful and great. When 

it was moved to a desk outside the lab requiring additional logon, it 

was not used at all. If the scanner could be at each medical assistant 

(MA) desk or each exam room, depending on MA preference, it would 

eliminate a lot of errors.” 

—Survey respondent

“You can’t train someone to a standard process and then not audit them 

and not follow up to make sure. Just because someone has been trained 

doesn’t mean that it’s not still going to fall to the wayside.” 

—Discussion participant
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 15

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 | www.cdc.gov

The findings and conclusions in this report are those of the 

authors and do not necessarily represent the official position of the 

Centers for Disease Control and Prevention.