Introduction: In 2017, Massachusetts Department of Public Health (DPH) sent a circular to all clinician practices approving medical assistants (MA) to administer vaccines. This approval for MAs to legally administer vaccines was new for the state of Massachusetts. Our large ambulatory care center with inconsistent practice expectations met this change by standardizing practices and successfully creating a comprehensive plan of qualifying, validating, training, and empowering their medical assistants to function at the top of their scope of practice.

Background: The DPH circular provided criteria regarding the recommended guidelines for education, experience, and training which allowed medical assistants to administer vaccines and the provision of supervision to adhere to in order to justify this practice. The multi-specialty ambulatory care center was comprised of several smaller and larger primary care practices acquired at various times to become one large entity. Prior to the application of this project, practices among the various sites ranged from some sites allowing MAs to administer vaccines, while other sites that did not.

Objective: The updated state guideline would ensure that patients would have easy access to vaccinations and that only select qualified medical assistants with validated vaccine training and skills could administer vaccines. The goal was to empower and train the current medical assistant workforce to safely administer vaccines while allowing them to practice to their full scope. Additional sub-goals included retention of staff and employee satisfaction.

Methods: Extensive collaboration and employee records documentation was required to ensure compliance with law and standardization. The plan was to integrate this practice not only with the current staff, but also in onboarding new MAs. Key stakeholders included legal, human resources (HR), safety, infection control, and practice leaders/administrators. This project required top leadership buy-in at all levels!

The project was implemented in four steps:
1) Identify MAs who qualify per state regulation to safely administer vaccines: implemented through legally vetted attestation forms, and processes which identified the MAs into two state approved categories.
2) Train the identified MA’s to administer vaccines: implemented by creating a comprehensive vaccine curriculum which included web-based online learning platform, in-person class, simulation of vaccine skills, and vaccine administration documentation. Curriculum included safe medication administration, handling and storage, adverse reaction identification, and recognizing and reporting unsafe practices.
3) Trained MAs required nurse validation of vaccine skills in supervised settings: implemented by requiring nurses to supervise and validate ten vaccine administrations during flu visits prior to MAs administering vaccines on their own.
4) Document successful candidates in centralized HR records: on completion, the manager/supervisor sends the names of successful candidates to be stored in the centralized HR system.

Outcome: By 11/05/2020, 30 MAs completed all the requirements, and another 24 have been scheduled for training. New processes were put in place including, a new job title, new list in HR for MAs eligible to administer vaccines, and new ID badges. They supported staffing by reducing workload on nurses. Supervisory requirements met at each site to keep patients safe, and MAs empowered with practice change.

Jeby Abraham George MSN, RN

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