Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People

Lynne J. Goebel · Shirley M. Neitch · Maurice A. Mufson

32 citations0/0 files storedJournal of the American Geriatrics Society

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Vaccine Coverage and Hesitancy Clinical practice guidelines implementation Intramuscular injections and effects

Abstract

OBJECTIVES: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients. DESIGN: Retrospective analysis of influenza vaccine usage over 4 years (1999-2002). SETTING: University ambulatory setting. PARTICIPANTS: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group. MEASUREMENTS: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used standing orders were compared with those of physicians who did not use standing orders. RESULTS: Five hundred seventy-six (63%) patients of physicians who used standing orders received influenza vaccine, compared with 332 (38%) patients of physicians who did not use them (P<.001). Standing orders accounted for a significantly higher rate of influenza vaccination in each study year. Moreover, in 2001, when influenza vaccine delivery was delayed, physicians who used standing orders maintained their same rate of usage, but physicians who did not had rates of about one-half their usage of the other 3 years. CONCLUSION: More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.

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References

2001Generalist and Subspecialist Physicians' Knowledge, Attitudes, and Practices Regarding Influenza and Pneumococcal Vaccinations for Elderly and Other High-Risk Patients 1998Ten-year durability and success of an organized program to increase influenza and pneumococcal vaccination rates among high-risk adults 1994Hospital-based strategies for improving influenza vaccination rates.1990Achieving the national health objective for influenza immunization: Success of an institution-wide vaccination program 1994Improving Compliance with Immunization in the Older Adult: Results of a Randomized Cohort Study 2000Standing Orders for Influenza Vaccination Increased Vaccination Rates in Inpatient Settings Compared With Community Rates 1998Demonstration of the feasibility of emergency department immunization against influenza and pneumococcus.1992Exporting a Successful Influenza Vaccination Program from a Teaching Hospital to a Community Outpatient Setting

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2010Interventions to increase influenza vaccination rates of those 60 years and older in the community 2011Use of Standing Orders for Adult Influenza Vaccination 2009Willingness to vaccinate and to be vaccinated in adults 2012

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