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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Childhood Vaccination with MMR, Flu, and HPV.

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Strategy. Standing Orders

Approach. Support the use of standing orders for childhood vaccines.

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Overview. Standing orders authorize nurses, pharmacists, and other healthcare providers where allowed by state law, to assess a client’s immunization status and administer vaccinations according to a protocol approved by an institution, physician, or other authorized provider.
Standing orders can be established for the administration of one or more specific vaccines to clients in healthcare settings such as clinics, hospitals, pharmacies, and long-term care facilities. In settings that require attending provider signatures for all orders, standing order protocols allow assessment and vaccination in advance of the provider signature.

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Provider self-efficacy and competency surveys
  • Electronic health record data on clinical documentation
  • Missed opportunities for vaccination audits

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of healthcare facilities partnered with Title V implementing standing orders for childhood vaccines. (Assesses adoption of strategy)
  • Number of healthcare providers trained by Title V on standing order protocols. (Measures capacity building)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of healthcare facilities partnered with Title V implementing standing orders for childhood vaccines. (Assesses adoption of strategy)
  • Percent of healthcare providers trained by Title V on standing order protocols. (Measures capacity building)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of quality improvement cycles conducted to refine standing order process that results in improvements on QI indices. (Shows commitment to ongoing improvement)
  • Number of best practices for standing order implementation shared across healthcare networks. (Measures knowledge dissemination)
  • Number of healthcare facilities showing sustained high vaccination rates with standing orders. (Quantifies long-term impact)
  • Number of policy changes at state or institutional level supporting expanded use of standing orders. (Evaluates broader system impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of quality improvement cycles conducted to refine standing order process that results in improvements on QI indices. (Shows commitment to ongoing improvement)
  • Percent of best practices for standing order implementation shared across healthcare networks. (Measures knowledge dissemination)
  • Percent of healthcare facilities showing sustained high vaccination rates with standing orders. (Quantifies long-term impact)
  • Percent of policy changes at state or institutional level supporting expanded use of standing orders. (Evaluates broader system impact)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Hong K, Leidner AJ, Tsai Y, Tang Z, Cho B, Stokley S. Costs of interventions to increase vaccination coverage among children in the United States: a systematic review. Academic Pediatrics 2021;21(4):S67-77.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.