Impact of State Law on Implementation of Standing Orders for Adult Immunizations in Acute Care Hospitals in New York City, 2008

Background:
In 2005, the New York City (NYC) Department of Health and Mental Hygiene's (DOHMH) Bureau of Immunization (BoI) conducted a survey to assess the use of standing orders in NYC acute care hospitals (N=68). In 2006, New York State (NYS) implemented Public Health Law Amendment #2805-h, requiring hospitals to offer influenza and pneumococcal vaccination to patients aged 65 years or older.

Objectives:
1) Determine the impact of the law in promoting standing orders policies
2) Determine the effect of standing orders policy on vaccination coverage

Methods:
In 2008, BoI conducted a follow-up survey assessing the adoption and implementation of standing orders for adult immunizations in healthcare facilities and self-reported vaccination rates in the facilities. Surveys were sent electronically, by fax or mail to emergency preparedness coordinators of acute care hospitals (N=65); completion rate was 100%. Each hospital received $5,000.

Results:
Results from the 2005 survey indicated that 65% (N=43) of hospitals reported having standing orders in place and 35% (N=15) monitored vaccination coverage rates. Results from the 2008 survey indicated that hospitals reporting use of standing orders increased to 91% (N=59) for influenza vaccine and 88% (N=57) for pneumococcal vaccine. Facilities that reported monitoring vaccination coverage levels increased to 66% (N=43). Facilities with inpatient standing orders for influenza and pneumococcal vaccination reported higher coverage levels compared to those without policies (55% [range: 1%-100%] vs. 38% [range: 3%-68%] and 57% [range 1%-100%] vs. 29% [range: 17%-55%], respectively). Similar results were seen for outpatient standing orders.

Conclusions:
The law requiring hospitals to offer patients vaccine and allow for standing orders was associated with more hospitals with standing order protocols and higher coverage levels. Standing orders should be promoted through state and national policies. Federal regulations should require standing orders and promote standardized reporting methods.