Toolkit assists pharmacists to increase adult immunization rates in North Dakota

March 21, 2018 – Fargo, North Dakota – The number of people affected by the flu season this year has been particularly high across the U.S. and in North Dakota, with children and those over 60 often hardest hit by the virus.

A project developed by the NDSU School of Pharmacy and Center for Immunization Research and Education in the NDSU Department of Public Health aims to help increase adult immunization rates in the state for flu, pneumonia and shingles. The North Dakota Department of Health provided a grant to fund the project.

In North Dakota, 41 percent of pharmacists are certified to administer immunizations. But out of all the immunizations delivered in the state, pharmacists provide just 9 percent of them, according to 2016 data from the North Dakota Immunization Information System.

The “Pharmacy-Based Immunization Toolkit” is designed specifically for North Dakota pharmacists to help close that gap.

“Pharmacists are often the most readily-accessible health care provider to many patients, particularly in rural areas,” said Elizabeth Skoy, associate professor in pharmacy practice at NDSU who led a team that developed the toolkit. “Offering these free online tools to pharmacists could assist patients and help the overall health of communities across the state,” said Skoy.

There are currently 20 counties in North Dakota with adult immunization rates below 30 percent, primarily in south central and western North Dakota. Older adults can be especially vulnerable to flu, pneumonia and shingles that can lead to complications, or they may be susceptible due to underlying health conditions, according to The site notes that vaccinations play an important role in overall health for individuals and communities.

A study in the journal Vaccine showed that in states where pharmacists could provide flu shots, people age 65 and over in those states had significantly higher flu vaccination rates than in states where pharmacists could not offer immunizations.

North Dakota pharmacists can access the free toolkit at

The robust Pharmacy-Based Immunization Toolkit includes:

  • A step-by-step guide to vaccinating adults
  • Vaccine information statements
  • A guide to precautions and contraindications
  • Screening questionnaires
  • Information on differences between shingles vaccines
  • Provider notification forms
  • Information on storage and handling of vaccines
  • Adverse events information and reporting
  • Vaccine billing
  • Information on vaccine administration, and
  • Promotional materials such as posters for pharmacies

In addition, a free three-hour, online continuing education program titled “Pharmacists as Immunizers: Updates, Barriers, and Implementation” is also available at

State law allows certified pharmacists to provide any immunization to individuals 11 years and older. Currently, 364 registered North Dakota pharmacists are authorized to provide immunizations, which represents only 41 percent of pharmacists in the state.

“The goal of this project funded by the North Dakota Department of Health is to increase adult immunization rates through targeted pharmacist education,” said Skoy.

Collaborators who developed the “Pharmacy-Based Immunization Toolkit” include Skoy, Michael Kelsch, associate professor of practice and vice chair of pharmacy practice at NDSU; and Dr. Paul Carson and Kylie Hall from the Center for Immunization Research and Education in the NDSU Department of Public Health; and the North Dakota Department of Health.

Contact for information about the program.

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