Standing Orders for Vaccination

IMPACT:

LOCUS:

ORIGIN: Community Guide systematic review

Publication Date: 12/07/2009

Author(s): NPO Staff

The Problem:

Vaccine coverage for  preventable disease is an essential public health goal. Low vaccine coverage rates enable otherwise avoidable outbreaks of harmful diseases. CDC: Vaccines and Immunizations. 

The Law:

To increase vaccination rates among specified adult populations, states authorize or require hospitals to create standing orders. Standing orders allow healthcare workers without prescription authority to prescribe and or administer vaccines under defined circumstances. Without standing orders, such vaccinations would be barred by laws regulating medical practice and the scope of patient-doctor relationships. Laws that provide standing order authority to non-physicians apply to registered nurses (Rev. Code Wash. § 18.79.260, Washington), pharmacists (N.D. Admin. Code 61-04-08-03, North Dakota) and physician assistants (ORS § 677.515, Oregon)

The Evidence:

In a systematic review, a Community Guide expert panel reviewed 11 studies assessing the use of standing orders to deliver vaccines to specified adult populations. Briss PA, Rodewald LE, Hinman AR, et al. Reviews of evidence regarding interventions to improve vaccination coverage in children, adolescents, and adults. Am J Prev Med 2000;18(1S):97-140. Of the 11 studies, six measured the impact of standing orders as an isolated intervention and five measured the effectiveness of standing orders in conjunction with other interventions. The reviewers identified a median 28 percent increase in vaccination among targeted populations following the adoption of standing order policies. The panel viewed all the results as strong evidence that standing orders improve vaccination coverage in adults as standalone intervention or as part of broader multifaceted interventions.

The Bottom Line:

In the judgment of a Community Guide expert panel, there is strong evidence supporting the effectiveness of standing orders as a public health intervention aimed at increasing vaccination rates.

Additional Information:

The Centers for Disease Control and Prevention has compiled and provides online access to all state vaccination laws.

The Immunization Action Coalition also provides online access to maps showing specific legal requirements for the fifty states.

Additional Resources: Centers for Disease Control and Prevention, Immunization Action Coalition

Categories:

What are Evidence Briefs?

A Public Health Law Research Program “Evidence Brief” summarizes the research assessing the effect of a specific law or policy on public health. 

Evidence Briefs are prepared by the staff of the National Program Office. Briefs are based on systematic literature reviews conducted by highly-regarded scholars and published by credible organizations or peer-reviewed journals. Evidence Briefs digest the best available evidence, but readers should bear in mind that even the best evidence may have limitations or deficiencies. 

The evidence briefs are organized by topic and intervention. Each law or policy is classified as “effective,” “uncertain” or “harmful,” according to the conclusions of the expert reviewers.  These are not independent conclusions of the NPO, nor do they reflect the views of the Robert Wood Johnson Foundation.

About the Links

Each Evidence Brief includes links to the study on which it is based. In many cases, the study is available in the public domain, but access to some may require a subscription.