The Problem: Widespread vaccine coverage for preventable disease is an essential public health goal Healthy People 2020 Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations. Clinicians tend to acute and chronic conditions before preventive considerations, resulting in lack of time for vaccinations. This leads to lower immunization rates and risks herd protection against vaccine-preventable diseases. Immunization Action Coalition (IAC)
The Law: Standing orders facilitate the delivery of vaccines and other immunization services in health-care settings such as clinics, hospitals and pharmacies and community settings. CDC: Standing Orders. Each of the 50 U.S. states and the District of Columbia separately regulates health care practitioners, clinicians, nurses and pharmacists. For examples of state immunization programs regarding standing orders, see N.J.A.C. 13:35–6.26 (New Jersey), U.A.C. R432-40-4 (Utah), D.C. Mun. Regs. Tit. 17, § 6512 (District of Columbia) and 49 Pa. Code § 21.16 (Pennsylvania).
The Evidence: An expert panel at the Community Guide systematically reviewed studies assessing the effect of vaccination programs on vaccination rates among adults and children in various settings. The review identified 35 studies that assessed the relationship between vaccination program standing orders and increasing vaccination rates among adults and children. Results showed a median increase in vaccination rates by 16% from standing orders alone, and a median increase of 27% when standing orders were used in combination with additional intervention strategies. Standing orders increased vaccination rates in children by a median increase of 28%. Though the authors acknowledge logistical difficulties in implementation of standing order interventions, they found that orders are effective in increasing vaccination rates among adults and children in various settings.
The Bottom Line: According to the authors of a Community Guide systematic review, there is sufficient evidence that vaccination program standing orders are effective in improving vaccination rates among adults and children within healthcare settings.
Additional Information: An example of effective standing order immunization programming in Jacksonville Florida. A Good Shot: Reaching Immunization Targets in Duval County, and a standing order information sheet from the Immunization Action Coalition. Using Standing Orders for Administering Vaccines: What You Should Know