Date of Award

Fall 2020

Project Type

Clinical Doctorate



Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Jessica Hatch

Second Advisor

Donna Pelletier



Background: Inventory control practices for adult vaccines, specifically Shingrix, in ambulatory clinics are not well known or researched. This quality improvement project takes place at a small healthcare organization consisting of a hospital and thirteen ambulatory clinics in Northern New England. Seven of the thirteen clinics have the Shingrix vaccine in their inventory.

Purpose: The aim of this quality improvement project was multifaceted. The first matter was the establishment of a two-week PAR level at seven of the thirteen ambulatory clinics connected to the organization. The second was the design and implementation of a Shingrix vaccine management program for seven of the thirteen ambulatory clinics. This included the redistribution of inventory to prevent loss. Lastly, to create an inventory management education program for our clinical staff.

Methods: A rapid review of the literature was conducted using an ELCLIPS format using the Business Source Ultimate database. An informal framework of LEAN was used for this project. Three months of baseline inventory evidence was collected (pre-COVID-19) and clinic PAR levels were established from an uncertain baseline inventory and use volume estimate.

Interventions: A manual inventory count was conducted at each clinic. Purchase and billing information was compared to the manual count obtained at each site. Two-week PAR levels were established by comparing use tallies to a three-month use rate (pre-COVID-19). These figures were extracted from the electronic health record. An educational plan for clinic employees was developed and personnel from each of the seven clinics participated.

Results: Seven months following the onset of the project’s implementation there were no recorded Shingrix vaccine losses and the administration of Shingrix vaccine has increased. Significant gaps in the literature regarding inventory management and ambulatory clinics were exposed. This quality improvement project ascertained evidence demonstrating a cost savings was obtained through improved Shingrix vaccine inventory management.

Conclusions: There are opportunities to improve Shingrix vaccine inventory management at the organization’s seven ambulatory clinics. The processes developed for this project are easily replicated and sustainable. Stakeholders within the organization have deemed this project financially beneficial to the organization and to the community: therefore, it has become a foundation for inventory management at our thirteen clinic sites.

Keywords: outpatient and ambulatory clinics, inventory, supply chain management, cost savings, resource stewardship, PAR levels