title: Characteristics of long-term care facilities associated with standing order programs to deliver influenza and pneumococcal vaccinations to residents in 13 states.
abstract: BACKGROUND
  Standing order programs (SOPs) are effective evidence-based interventions in which nurses or pharmacists are authorized to vaccinate according to an approved protocol without a physician order or examination. National rates for influenza and pneumococcal vaccination in long-term care facilities (LTCF) are far below HP2010 goals of 90%.
  
  
  OBJECTIVE
  The aim of this study was to describe the prevalence of SOPs and other types of immunization programs in LTCFs and determine characteristics of LTCFs implementing SOPs.
  
  
  METHODS
  Mailed survey.
  
  
  METHODS
  All Medicare- or Medicaid-licensed LTCFs in 13 states.
  
  
  METHODS
  Directors of Nursing (DONs).
  
  
  METHODS
  Survey collecting information on SOPs and barriers to their use in respondents' LTCF. Data from this survey were linked to the On-line Survey and Certification Administrative Record (OSCAR), a federal administrative database containing structural, staffing and other information on LTCFs.
  
  
  RESULTS
  A total of 3,451 of 4,366 (79%) LTCFs completed surveys. Few facilities used SOPs for influenza (9%) or pneumococcal vaccination (7%). The greatest use of influenza SOPs compared with other immunization program types were seen in facilities that were government owned or owned by nonprofit entities compared with for-profit entities (15% and 10% vs. 7%; odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.5 to 3.4 and OR = 1.4, CI = 1.1 to 1.8, respectively); dually-certified (both Medicare- and Medicaid-certified) nursing facilities compared with distinct part skilled nursing facilities in which beds are set aside for residents with a specific payment source (11% vs. 7%; OR = 1.6, CI = 1.3 to 2.1); independent facility compared with one that is part of a multi-facility chain (10% vs. 7%; OR = 1.3, CI = 1.1 to 1.7); and lower acuity index (resident resource needs) compared with higher (10% vs. 7%; OR = 1.4, CI = 1.1 to 1.7). Findings were similar for pneumococcal vaccination SOPs. SOP use varied substantially by state (range = 0% to 23% influenza; range = 3% to 15% pneumococcal). The most frequently reported barriers to SOP use were legal concerns: liability for the facility (53%) and staff lacking legal authority (39%) to vaccinate by standing orders.
  
  
  CONCLUSIONS
  Although LTCFs with certain characteristics used SOPs more often, overall few facilities (<10%) used SOPs to improve vaccination rates. SOP use varied by state indicating that state policies or other factors may promote or inhibit SOP use. More studies are needed to examine the causes of state-level variations in vaccination interventions and their relationships to health outcomes of residents in LTCFs. The federal government's resources to promote SOPs should focus on all LTCFs, but with a particular focus on those that are less likely to be using SOPs and that represent a large proportion of homes nationally (i.e., for-profit and chain facilities).
authors.affiliation: National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ashefer@cdc.gov
authors.forename: Abigail
authors.initials: A
authors.lastname: Shefer
authors.forename: Linda
authors.initials: L
authors.lastname: McKibben
authors.forename: Barbara
authors.initials: B
authors.lastname: Bardenheier
authors.forename: Dale
authors.initials: D
authors.lastname: Bratzler
authors.forename: Henry
authors.initials: H
authors.lastname: Roberts
mesh_terms: D000368:Aged; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007251:Influenza, Human / Q000517:prevention & control*; D016014:Linear Models; D008134:Long-Term Care / Q000592:standards; D006278:Medicare; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000592:standards / Q000706:statistics & numerical data*; D016134:Organizational Policy; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022242:Pneumococcal Vaccines