BACKGROUND:
Standing order programs (SOPs) are effective interventions in which nurses or pharmacists are authorized to vaccinate by institution-approved protocol without a physician order. During 1999-2002, a demonstration project was conducted in long-term care facilities (LTCFs) to increase adoption of SOPs for influenza and pneumococcal vaccines.

OBJECTIVE:
To explore the relationship between facility vaccination rates and characteristics of LTCFs.

METHOD:
At baseline (2000), a self-administered survey was mailed to each of 20 LTCFs in the 14 participating states (n=280). Survey responses were linked to OSCAR, an administrative database containing information on all licensed LTCFs. Facility coverage was determined by samples derived from residents’ on-site chart abstractions. Logistic regression models were used to study the overall association between coverage rates and LTCF characteristics.

RESULT:
Two hundred forty seven (89%) of the sampled LTCFs had complete information. Overall, facility-level coverage for influenza and pneumococcal vaccine averaged 59% and 35%, respectively. On bivariate analyses, SOPs were associated with higher coverage for both vaccines (p<0.01). Logistic regression showed that characteristics of LTCFs having higher coverage rates for both vaccines were: 1. dually certified skilled nursing facility; 2. government ownership; and 3. high occupancy rates. Additional predictors for influenza vaccination were hospital administered facility, resident case mix (CMI index) indicating less patient resource needs, vaccine documented in a consistent place in chart, and having a centralized vaccine tracking system; and for pneumococcal were LPN primarily responsible for vaccinating, offering vaccine if unknown vaccination history, and written consent not required for vaccination.

CONCLUSION:
Although SOPs appeared to be associated with higher coverage rates, other factors considered to be part of a functioning SOP (i.e., tracking of vaccinations and not requiring written consent) appeared to play a more important role. These factors may form the foundation for LTCFs wishing to improve vaccination. Offering vaccine when the vaccination history is unknown may be especially important for pneumococcal vaccine in which prior vaccination may be more difficult to document.

LEARNING OBJECTIVES:
To understand factors associated with vaccination in LTCFs.