Publication Date: 
Sunday, July 12, 2009

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.