CDC | NCIRD Workflow Determination Tool for Vaccine Administration 1

WORKFLOW DETERMINATION TOOL

FOR VACCINE ADMINISTRATION

Vaccine 2D Barcode Scanning 

Implementation Toolkit 

National Center for Immunization and Respiratory Diseases (NCIRD)

Centers for Disease Control and Prevention (CDC)
1 Introduction

2 Communicate Plans for Implementation

3 Workflow Redesign Session: Gather Stakeholders

4 Workflow Redesign Session: Understand the Current Workflow

5 Workflow Redesign Session: Identify Potential Scanner Locations

6 Workflow Redesign Session: Discuss Logistics

7 Workflow Redesign Session: Determine Technology Needs

8 Adjust Protocol and Update Training Materials

9 Resources

Con

Table of 

tents
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 1

Introduction

The Workflow Determination Tool is intended for site-level administrators and staff 

members who may be responsible for the vaccine administration workflow. The 

Tool provides suggested steps and supporting resources for revising the vaccine 

administration workflow to incorporate two-dimensional (2D) barcode scanning.

This Tool is part of the Vaccine 2D Barcode Scanning Implementation Toolkit, which 

contains a series of resources and tools to support different aspects and phases 

of vaccine 2D barcode scanning implementation in ambulatory clinics, health care 

facilities, or health systems.

Redesigning the Vaccine Administration Workflow 

for 2D Barcode Scanning

Thoughtful incorporation of 2D barcode scanning into the vaccine administration workflow is key 

for high staff engagement and consistent scanning rates. Follow the steps below to determine 

how to best incorporate scanning into your clinic’s workflow. Further details on the steps can be 

found throughout this Tool.

1 Communicate plans for 2D barcode scanning implementation to staff.

Educate staff on 2D barcode scanning, communicate changes that they should 

anticipate, and request participation and cooperation.

Prepare for and conduct workflow redesign session. 

Review the floorplan and current vaccine administration workflow in order to 

brainstorm potential 2D barcode scanner locations. Collaborate and negotiate 

within the team to agree on scanner locations and determine additional 

technology needs based on the redesigned workflow.

2

Adjust protocol/standard operating procedure (SOP) and update 

training materials to match redesigned workflow.

Prepare for the roll-out of the redesigned workflow to all staff and other 

stakeholders.

3
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 2

Communicate Plans for Implementation 

Once your site has decided to implement vaccine 2D barcode scanning, ensure that the 

leadership and staff are aware of, and educated about, the initiative. Staff members’ daily 

activities may be affected by the implementation, so it is important that they are on board and 

included in the planning process.

 Review the other materials in the Toolkit, including the one-pager, that can assist with raising 

awareness and educating staff members about the project.

 Consider stakeholders and staff affected by workflow changes.

• Determine the appropriate venue for information-sharing with each stakeholder group. 

 Venues may include weekly meetings, daily huddles, email announcements, fliers in the 

 breakroom, or the workflow redesign session. 

• Provide a forum for questions and answers and provide contact information so that 

 stakeholders can ask questions later.

 Include answers to the following questions when communicating with stakeholders: 

• WHAT is 2D barcode scanning?

• WHY implement 2D barcode scanning rather than continue with the existing workflow?

• WHEN will 2D barcode scanning be implemented?

• WHO will 2D barcode scanning benefit? 

• HOW can stakeholders participate in the implementation of 2D barcode scanning and 

 prepare for a workflow redesign session?

1

Key for success: Engage leaders and staff in scanner implementation 

discussions—their expertise is valuable and their buy-in is critical.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 3

Workflow Redesign Session: Gather Stakeholders 

Key stakeholders will need to collaborate for a productive redesign session. The introduction of 

2D barcode scanning into the vaccine administration workflow will require brainstorming and, 

potentially, iterations with the staff’s input. It is important that the appropriate stakeholder 

groups and decision-makers are present. Inviting the key stakeholders will enable open 

discussion about the feasibility of the redesigned workflow.

2

Project lead

Project champion

Electronic medical 

record (EMR) 

personnel 

IT personnel

Office manager

Vaccine coordinator

Head nurse

Medical assistant(s)

Potential Attendees Considerations

y Include health care providers in workflow

redesign discussions so they can voice

their preferences, contribute their dayto-day expertise with the workflow, and

identify any concerns from the start.

y Consider who may need to be consulted

regarding:

x The purchase of scanners.

x The installation of scanners.

x The procurement of additional tools

(e.g., computer, stands, mobile 

workstation).

x The location of the scanners and

additional tools to easily integrate the

process into current workflow.

y Think of key decision points,

opportunities, and barriers that are best

discussed in person.

y Determine which levels of leadership,

if applicable, should be engaged in the

session and which may be updated later.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 4

1. Start by drawing out the floorplan of the site

using available materials (e.g., whiteboard,

paper) to help with visualization of the current

vaccine administration workflow.

2. List each step of the current workflow, using

the sample process map to the right as an

example. Determine what level of detail

may be needed. Revisit your process map

throughout the discussions to edit as needed.

y Consider writing the steps on sticky

notes so they can be moved around

and reordered.

y Keep in mind the resources (e.g.,

computer) and physical location (e.g.,

medication refrigerator, patient room)

required for each step.

3. Assign the steps in the process map to the

respective locations on the floorplan using

sticky notes. Include arrows to show the order

of events.

4. Review the process map for feasibility and the

floorplan for accuracy and ensure the health

care providers validate the information.

Activity

Workflow Redesign Session: Understand the Current Workflow 

Before diving into a redesigned workflow, consider taking the time to draw and visualize the 

current workflow. Starting discussions with the existing process may help the team incorporate 

2D barcode scanning seamlessly into the current workflow.

2

Sample Process Map of Current Workflow

Receive patient vaccine order

Properly dispose of waste

Manually enter National Drug 

Code (NDC), lot number, and 

expiration date into the EMR

Complete vaccine record manually 

(e.g., time, site of vaccination)

Collect ordered vaccine

Prepare vaccine 

Provide patient with Vaccine 

Information Statement (VIS)

Administer vaccine

Save vaccine 

administration record

Notes
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 5

2 Workflow Redesign Session: Identify Potential Scanner Locations

Discuss options for where the step “Scan 2D barcode on vaccine” could be incorporated 

into the current vaccine administration workflow. Discuss the location of scanners, if the 

location aligns with the redesigned workflow, and if the scanner location encourages 

scanning prior to administration. The goal is to make scanning second nature so that it 

seamlessly fits into the redesigned workflow.

Activity

Location Benefits Identified Challenges Identified

Refrigerator/ 

Draw Area

• Pulling/preparing vaccine

already occurs in this area.

• Single or fewer computers/

scanners needed, even for

greater staff and vaccine volume.

• May require new computer,

if not already there.

• Back up scanner suggested,

during busy times or if the

primary scanner has problems.

Individual 

Desks

• Enough computers may already

be in place.

• Familiar location for previous

entry/workflow process.

• May add steps (worse for some

layouts) if not part of vaccine

administration path.

• Requires as many scanners as 

individual work stations.

The scanner location should: 

9 Be convenient or in the line of sight for health care providers’ workflows (e.g., near vaccine

refrigerator, draw stations, verification locations, or other obvious locations).

9 Minimize extra steps to seamlessly blend scanning into the vaccine administration workflow.

9 Support scanning prior to administration of vaccines to maximize benefits, including:

x Pop-up alerts, as available, to warn staff of incorrect or expired vaccines

x Immediate disposal of used products (e.g., syringes or vials), so that staff do not need to

retain them for data entry

Benefits and challenges of two common scanner locations are identified in the table below.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 6

Workflow Redesign Session: Discuss Logistics

Once ideal locations for scanners have been identified, discuss the logistics for installing the 

scanners in the identified locations. It is possible that some barriers to adherence may be 

anticipated during logistics discussions and can be prevented with new equipment, rearranging 

of rooms, or other creative solutions.

The IT support, EMR staff, and office manager should be engaged in the workflow redesign 

session to discuss the feasibility of scanner installation in the desired location and to help decide 

what additional equipment—including computers with EMR software installed, scanner stands, 

scanner mounts, corded scanners, or cordless scanners—is needed to best integrate 

2D barcode scanning into the workflow.

Considerations 

y Is there enough space at the potential location to accommodate a scanner? 

x Is there space on the counter/surface for the scanner and a stand? 

x Is there space on the wall for the scanner and a mount? 

x Could a wireless scanner provide more flexibility? 

y Can the room be rearranged (e.g., desks, refrigerator) to accommodate the scanner and 

the workflow? 

y Is there a computer or computing device in the room? 

y Is there space on the wall or near the scanning station to store configuration barcodes and 

troubleshooting tips?

y Is there space on the wall or near the scanning station to post reminders to scan? 

y Can a wireless scanner solve any problems around computer location or lack of space? 

Staff may need to test and iterate to come to a consensus on a process that is best for the 

workflow. Additionally, stakeholders may need to work with the office manager to determine 

the technology and hardware to be purchased, moved, and installed. Note that in a large health 

system, procurement decisions may be made centrally, and stakeholders will need to work with 

this central entity.

2

Findings from a 2016 to 2017 pilot found that, in aggregate, installing 

scanners in multiple locations led to higher scanning rates than at a 

single location. In particular, the refrigerator/draw/prep area paired 

with another location (used equally or as a primary with a backup) had 

the highest scanning rates.

View the Lessons Learned supplement for more details on the 2016 to 

2017 pilot and additional findings.
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 7

Workflow Redesign Session: Determine Technology Needs 

Use the checklist below as a guide to document the 2D barcode scanner locations and to 

describe the technology needs to IT staff, EMR staff, and/or the office manager. Make sure 

that all scanners, scanner support equipment, and scanner locations are included while 

reviewing the checklist.

2

List potential scanner locations.

Consider number of scanners needed at each location.

Confirm if a computer or computing device is present at all locations.

Identify any computers that may need to be moved to a different 

location.

Determine if any computers would need to be installed.

Determine if wired and wireless scanners may be preferred in each location. 

If a wired scanner is preferred, determine if there is a minimum 

length cord required. 

Determine if wall mounts or stands would be needed or desired at each 

location. 

Determine if any scanners would be used at a mobile station and if 

additional materials or hardware would be needed. 
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 8

Adjust Protocol and Update Training Materials 

Any adjustments to the vaccine administration workflow should be communicated to 

staff. Train staff on new protocols and SOPs to ensure consistent 2D barcode scanning 

during vaccine administration in daily practice.

Adjust Protocol | To promote buy-in to new scanning protocols for vaccine 

administration, staff should be informed of any adjustments to protocol (e.g., whether 

scanning is mandatory or a highly encouraged practice).

Determine if scanning should be a mandatory practice.

Communicate expectations from the start about how scanning will be monitored.

Adjust SOPs and quality-assurance procedures to match the redesigned workflow.

Ensure that staff members are clear on expectations prior to the training and address 

any questions or feedback that they may have.

Update Training Materials | To reduce any potential confusion, training materials 

should be reviewed and tailored to match your site’s needs. 

Confirm that training materials match the redesigned workflow and specify the new 

protocol.

Walk through the redesigned workflow, if possible, to ensure that all staff members 

have a clear understanding of any changes.

Keep training materials accessible to staff to reference as needed.

Anticipate Protocol Breaches | An inconvenient workflow can deter health care 

providers from practicing proper vaccine 2D barcode scanning. Anticipate potential areas 

of noncompliance and proactively address them in the revised protocol and staff trainings. 

The vaccine should be scanned PRIOR to vaccine administration to take advantage

of safety measures (e.g., alerts to confirm that the scanned vaccine matches the 

vaccine order). 

The time of vaccination and site of injection should be entered AFTER vaccine 

administration when these data points become available.

3

It can be hard to adjust to a new workflow and deal with 

challenges when the staff is already busy.

An alternate workflow may be beneficial or necessary during 

mass vaccination periods, such as flu season.

Consider how the workflow may be impacted during busy times of the year:
CDC | NCIRD Workflow Determination Tool for Vaccine Administration 9

Resources 

More information on incorporating 2D barcode scanning into the vaccine administration 

workflow can be found in the following documents: 

Lessons Learned on Workflow from Scalability Pilot 

Implementation Pilot for Two-Dimensional (2D) Vaccine Barcode Utilization: Additional 

Workflow Analysis (WFA) Final Report
CDC | NCIRD Technical Implementation Guide: Vaccine Administration 24

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.