Tag: standing orders

Standing Orders for Vaccination

Have you heard about standing orders for vaccination?

Anti-vax folks have become overt in how they are now all about conspiracy theories.
Anti-vax folks have become overt in how they are now all about conspiracy theories.

Guess what?

Standing orders does not mean “covert vaccination without consent.”

Standing Orders for Vaccination

For one thing, there is nothing covert about them.

In addition to the Take a Stand! website, the Immunization Action Coalition has hosted workshops all over the United States on using standing orders to increase vaccination rates.

And they aren’t about vaccinating people without their consent.

So what are standing orders for vaccination?

“Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified health care professionals (who are eligible to do so under state law, such as registered nurses or pharmacists) to assess the need for and administer vaccine to patients meeting certain criteria, such as age or underlying medical condition.”

10 Steps to Implementing Standing Orders for Immunization in Your Practice Setting

Again, that doesn’t mean you can skip getting informed consent before giving vaccines.

“Having standing orders in place streamlines your practice workflow by eliminating the need to obtain an individual physician’s order to vaccinate each patient.”

10 Steps to Implementing Standing Orders for Immunization in Your Practice Setting

All standing orders do is eliminate the need for doctors and other health care providers to assess and write orders for vaccines on each and every patient they see.

Instead, standing orders help delegate that part of the vaccination process to other qualified health care professionals to help make sure that “immunizations are available at all visits, sick or well, regular hours, or weekend clinics.”

Everything else is essentially the same.

Even with standing orders, you still have to get informed consent before giving a vaccine.
Even with standing orders, you still have to get informed consent before giving a vaccine.

The health care provider giving the vaccine still has to:

So what’s the benefit of standing orders?

It removes some of the barriers to getting vaccines, such as needing a well child checkup or physical exam, allowing for vaccination-only appointments.

“The Community Preventive Services Task Force (CPSTF) recommends standing orders for vaccinations—when used alone or when combined with additional interventions—to increase vaccination rates among adults and children from different populations or settings.”

Vaccination Programs: Standing Orders

Standing orders also help make sure that you keep kids on schedule or get them caught up as health care providers automatically check their vaccination status at each and every visit to the office, even during sick visits.

For example, if you child comes in for an appointment in October with a mild ear infection or because they have a wart, a standing order for a flu vaccine can help make sure you child is vaccinated and protected before flu season starts.

Standing orders do not override laws requiring informed consent.
Standing orders do not override laws requiring informed consent and there is no single form that would give consent to all medical procedures.

It should be obvious that standing orders simply lead to fewer missed opportunities to be vaccinated and protected.

Not surprisingly, their source and evidence for forced vaccination is simply another anti-vaccine website...
Not surprisingly, their source and evidence for forced vaccination is simply another anti-vaccine website…

There is nothing covert about them.

“Consent is a communications process, not a form. The process provides an opportunity for the patient to understand the benefits, risks and alternatives to the treatment he or she is about to undergo, and for the physician to explain these in detail. Forms are used to document the process.”

Consents Policy

Not even in the way anti-vax are using them to try and scare you away from vaccinating and protecting your kids.

More on Standing Orders for Vaccination

Anti-Vax Groups Are Targeting Minority Communities

It’s a big deal that anti-vax groups are targeting minority communities.

Anti-Vax Groups Are Targeting Minority Communities

Some of these communities already have low vaccination rates and have been hit with outbreaks of vaccine-preventable diseases.

Anti-Vax Groups Are Targeting Minority Communities

Unfortunately, Bobby Kennedy and the latest Harlem Vaccine Forum isn’t the first time this has happened.

Remember when Andy Wakefield, JB Handley, and others targeted Somali immigrants in Minnesota?

How about when opponents of new vaccine laws in California targeted Latinos in the community?

Why is this a problem?

“Q: I do have a question, on behalf of the Hispanic media, and also the African-American media. Rates for vaccinations have been historically low. Could you tell us what those communities can do to try and raise those rates, please? And also, the issues that they’re facing?

WILLIAM SCHAFFNER, MD: I think it’s very important that, number one, we reach out in ways to communicate with the minority communities in our country, and that we work with the leadership of those communities to actually educate those communities, bring them in, and to provide access, so that we can actually extend the benefit of vaccination to them. Colleagues?

PATRICIA WHITLEY-WILLIAMS, MD: I would certainly agree with that. I also would say, I am a member of the National Medical Association, which is an association predominantly of African-American physicians. We know about the disparities, with regards to vaccination coverage rates, both in adults and in children. But we also know about the deaths and severity of disease related to flu and pneumococcal infections; there is a disparity there, in terms of hospitalizations and deaths among underrepresented minorities in this country.

It is through education. It also depends on that relationship between adult patients and their providers. Again, there should be no opt-out. Patients need to understand that they’re tremendously at risk, and there is a disparity. As I think we all know, there is a historical context and a belief that exists in the African-American community, in terms of maybe mistrust of the medical system, because of experimentation that had gone on earlier. And again, it’s trying to provide that information and education through providers.”

National Foundation For Infectious Diseases (NFID) September 26, 2019

It is well known that many minority communities have low immunization rates.

“Since 1995, annual estimates of MMR vaccination coverage and poliovirus vaccination coverage increased among all children aged 19–35 months, and since 2007, disparities between racial/ethnic minorities and non-Hispanic white children for these vaccines has been nonexistent.”

Reduction of Racial/Ethnic Disparities in Vaccination Coverage, 1995–2011

Tragically, we are losing many of the gains that we had recently seen in reducing the gaps in vaccination among some racial/ethnic groups.

“HPV vaccine follow-through is lower in racial and ethnic minorities than Whites.”

Spencer et al on Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis

In addition to children and teens, we are seeing growing disparities among adults too.

“On further examination, it is evident that some populations receive vaccinations at a level below other populations. For instance, 31% of Hispanic individuals received influenza vaccine in 2014 compared to 34.4% of African American and 46% of White Americans. This difference is also apparent in populations that receive pneumococcal and herpes zoster vaccines. These differences represent disparities in the use of nationally recommended vaccines.”

Anthony Pattin on Disparities in the Use of Immunization Services Among Underserved Minority Patient Populations and the Role of Pharmacy Technicians: A Review

We must continue to work to remove barriers to access to vaccination and encourage providers in these communities to get the message out that vaccines are safe, with few risks, and are obviously necessary.

“There are many Latino and African-American physicians who have a practice that predominantly serves a population of the same ethnicity. We really rely on those providers to help us get the word out, as the press will. These patients trust their providers. We also need to involve community-based organizations to help us in getting the message out as well.”

Patricia Whitley-Williams, MD

Providers, especially in those communities that are being targeted, can improve vaccination rates by:

  • using standing orders, especially during flu season
  • using reminder and recall systems so that everyone knows when they are due for their vaccines
  • providing consumer-oriented information about vaccines to help overcome any negative perceptions, misinformation, and fears parents might have

Don’t allow anti-vaccine propaganda and misinformation to infect your community and make your job harder or put your kids at risk to get a vaccine-preventable disease.

More on Vaccines and Minority Communities

Strategies for Increasing Childhood Vaccination Rates

How do we improve vaccination rates?

A very clever immunization reminder system for parents.
A very clever immunization reminder system for parents.

One way is to help parents get educated about vaccines, so that they understand that vaccines work, vaccines are safe, and that vaccines are necessary.

Strategies for Increasing Childhood Vaccination Rates

Vaccine-hesitant parents who might delay or skip some of their child’s vaccines aren’t the only reason vaccination rates aren’t where they should be though.

“Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice.”

CDC on The Need for Strategies to Increase Immunization Levels

How do we fix these gaps in immunization rates?

Some easy things to do that can help increase vaccination rates might include:

  • regularly posting vaccine education material on your social media accounts
  • maintaining a good supply of vaccines
  • reminding parents to bring their immunization records with them to each appointment, especially if they are new patients
  • keeping accurate immunization records on each patient
  • carefully recording vaccines that have been given outside your office
  • using an immunization information system or immunization registry to make it easier to keep track of immunization records
  • generating lists of patients who’s vaccines are past due
  • using reminder and recall messages, either phone calls, text messages, or postcards, etc., so that parents are notified when vaccines are due soon or past due
  • using an electronic health record system to automatically generate prompts when vaccines are due at well visits and sick visits
  • manually reviewing your patient’s vaccination status at each visit, whether it is a sick visit, well visit, or just a nurse visit, to see if they need any immunizations. Remember, a mild illness is not usually a contraindication to getting vaccinated.
  • reducing missed opportunities to vaccinate kids by using standing orders and “nurse only” or “shots only” visits for vaccinations
  • having extended hours for some scheduled or walk-in vaccination clinics
  • enrolling in the Vaccines for Children program to provide free vaccine to families who are uninsured

And most importantly, office staff need to get educated about vaccines too, especially about the anti-vaccine talking points that might keep some kids from getting vaccinated on time. They should also understand the immunization schedule and catch-up immunization schedule, so they can easily recognize which vaccines are due.

“Pediatricians in the sample often provided parents with inconsistent, mixed messages and sometimes offered information about HPV or HPV vaccination that was inaccurate. Pediatricians used presumptive language in only 11 of 75 encounters; when used, presumptive language was associated with higher odds of accepting HPV vaccine.”

Sturm et al, on Pediatrician-Parent Conversations About Human Papillomavirus Vaccination: An Analysis of Audio Recordings

Pediatricians who are getting frustrated talking to parents who have been refusing vaccines might also learn a few new things, including how to use presumptive language.

What is presumptive language?

In the HPV vaccination study quoted above, it was defined as “a matter-of-fact statement that the child was due for or would receive HPV vaccine that day or at a future date, conveying a positive stance toward vaccination.” This is in contrast to a nonpresumptive style that “involved questions or uncertainty,” such as “do you want to get a shot today?”

“High-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them.”

Gilkey et al, on Provider communication and HPV vaccination: The impact of recommendation quality

In addition to using presumptive language, another study has found that “By endorsing HPV vaccine highly, recommending same-day vaccination, and emphasizing cancer prevention, providers may be able to promote HPV vaccine initiation and completion while discouraging vaccine refusal and delay.”

Can these strategies work for your office?

What to Know About Increasing Childhood Vaccination Rates

From using reminder systems and standing orders to changing how you talk to parents, there are a lot of things that can be done to increase childhood vaccination rates.

More on Increasing Childhood Vaccination Rates