P0058 - The Effects of Vaccine Standing Orders on Pediatric Vaccination Rates

Background: Vaccinations are one of the greatest public health achievements of the 20th century, leading to a reduction in morbidity and mortality associated with the infectious diseases they prevent. Unfortunately, vaccination rates within the United States have been declining, and many of these vaccine-preventable diseases are again on the rise. Due to this, methods to increase vaccination rates are being explored. Vaccine standing orders are one method being employed.

Methods: Standing orders are pended orders that allow members of the care team to administer ordered vaccines the patient is due for at any encounter. Our project explored the effects vaccine standing orders had on the number of pediatric vaccinations administered in one South Dakota family medicine clinic, where staff are not as comfortable with the immunization schedule. Nursing staff looked at state and EMR records to determine what immunizations the pediatric patients, defined as those 18 and under, were due for according to the Center for Disease Control’s (CDC) recommended vaccination schedule. They then placed standing orders in the patient’s chart based on these findings. The number of vaccines administered during a five-month period before (January 1st-February 28th, 2019) and a five-month period after (June 1st-October 31st, 2019) the implementation of standing orders were compared. Results were then analyzed using an independent samples t-test. Our null hypothesis was that vaccine standing orders would not result in an increase in pediatric vaccination rates.

Results: The total number of vaccinations administered to pediatric patients prior to standing orders was 183. Percentages per month were as follows: January 46, February 26, March 47, April 21, May 43. The total number of vaccinations administered to pediatric patients after implementation of standing orders was 394. Percentages per month were as follows: June 74, July 72, August 92, September 79, October 77. The average number of vaccines given per month more than doubled, with an average of 37 vaccines administered per month pre-standing orders and 79 administered per month post-standing orders. This resulted in an increase in vaccination rates by 113.5 percent. The resultant p-value was 0.0002, allowing for rejection of the null hypothesis.

Conclusions: Our project showed a significant increase in the number of immunizations administered with the implementation of vaccine standing orders in this South Dakota clinic. A limitation in this study was the short time frame, preventing us from controlling for seasonal variation in vaccines (e.g. influenza vaccination). Another limitation was the small sample size. Our plan is to continue the intervention and to continue monitoring results retrospectively to evaluate sustainability. Overall, this study showed standing orders can be an effective method to improve vaccination rates within the pediatric population.