Targeted Vaccinations: Standing Orders
Standing orders programs authorize nurses, pharmacists, and other healthcare personnel where allowed by state law, to assess a client's immunization status and administer vaccinations according to a protocol approved by an institution, physician, or other authorized practitioner. The protocol enables assessment and vaccination without the need for examination or direct order from the attending clinician at the time of the interaction.
Standing orders can be established for the administration of one or more specific vaccines to clients in health care settings such as clinics, hospitals, pharmacies, and long-term care facilities. In settings that require attending clinician signatures for all orders, standing order protocols permit assessment and vaccination in advance of the signature.
Summary of Task Force Recommendations & Findings
The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of standing orders, when implemented alone, in increasing influenza, pneumococcal polysaccharide, or hepatitis B vaccination coverage among high-risk adults because no studies qualified for review.
Results from the Systematic Reviews
No studies were identified that evaluated standing orders when used alone.
These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to vaccinations to prevent diseases.
Economic Review
An economic review was not conducted because the Task Force found insufficient evidence to support the intervention.
Supporting Materials
- Analytic framework
[PDF - 728KB] - see Figure 1 on page 251
Publications
CDC. Improving influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among adults aged <65 years at high risk: a report on recommendations of the Task Force on Community Preventive Services. MMWR 2005;54(No. RR-5):1-12. 
Task Force for Community Preventive Services. Recommendations to improve targeted vaccination coverage among high-risk adults. [PDF - 97KB] Am J Prev Med 2005:28(5S);231-7.
Ndiaye SM, Hopkins DP, Smith SJ, et al. Methods for conducting systematic reviews of targeted vaccination strategies for The Guide to Community Preventive Services. [PDF - 132KB] Am J Prev Med 2005:28(5S);238-47.
Ndiaye SM, Hopkins DP, Shefer AM, et al. Interventions to improve influenza, pneumococcal polysaccharide, and hepatitis B vaccination coverage among high-risk adults: a systematic review. [PDF - 728KB] Am J Prev Med 2005:28(5S);248-79.
Task Force on Community Preventive Services. Vaccine preventable diseases. [PDF - 97KB] In : Zaza S, Briss PA, Harris KW, eds. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005:223-303.
More Community Guide publications about Vaccinations to Prevent Diseases
Disclaimer
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC.
Sample Citation
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Targeted vaccinations: standing orders. www.thecommunityguide.org/vaccines/targeted/standingorders.html. Last updated: MM/DD/YYYY.
Review completed: October 2001
- Page last reviewed: February 7, 2011
- Page last updated: December 3, 2011
- Content source: The Guide to Community Preventive Services
