Standing Orders for Vaccinations in Our Offices :

In our quest to increase vaccination rates, a strategy that has gotten some attention involves the use of standing orders to ensure our patients get immunized. But how eager are we to use standing orders?  Are there barriers to their use that prevent us from trying this strategy?  To answer these questions, Cataldi et al (10.1542/peds.2019-1855) surveyed a nationally representative group of 471 of our pediatric colleagues, getting responses from 372 of them (79%) asking if they use standing orders and what were the barriers preventing those who don’t use this approach. The first interesting finding one comes across is that only 59% of pediatricians surveyed use standing orders. Do you think this is higher or lower than expected?  If you think it should be higher, the authors note that there were three barriers that prevented colleagues from using this strategy, including fear of a child being given the wrong vaccine, the belief that there needs to be conversation between pediatrician and parent rather than just have the nurse come in and administer the vaccine, and that an in-person recommendation makes a difference rather than an impersonal order that results in a vaccine being offered that could just as well be refused by a family who does not feel personally engaged in this decision. If you think the rate of 59% is better than you expected, the authors also provide the factors that are associated with the use of standing orders that might lead you to want to institute them as well if you haven’t already.  Instituting standing orders and seeing if that improves vaccination rates would make a great quality improvement project, and if you don’t want to try standing orders, then consider some other strategies that we have suggested in prior articles such as text messaging your patients (10.1542/peds.2018-2500).