Since 2004, pharmacists at the University of Wisconsin Hospital and Clinics have screened all adult inpatients for pneumococcal and influenza vaccination. Rates of screening patients improved to nearly 100% between 2004 and 2009, but the rate of actual administration of the vaccines hovered around 45%. A review of the process identified failure modes. This prompted a collaborative effort between pharmacy and nursing for improvement that focused on ensuring that the ordered vaccinations were actually administered. The rates of administration improved from approximately 45% in June 2009 to approximately 78% by mid-2010.