Standing Orders
| Standing orders in a medical facility allow registered professional nurses to administer immunizations and agents used in emergency treatment of anaphylaxis without patient specific orders from a doctor. |
A primer on Standing Orders (Standing Order and Protocol Guidelines) lists the vaccines that fall under these standing orders, and explains in detail the protocol to administer vaccines and protocol for anaphylactic treatment. To implement standing orders in your office, simply follow the procedures and protocols as they are listed in the primer.
As a general rule, these principles should accompany the implementation of standing orders and adult immunization practices in your office:
- • Patients rely on the medical advice of their doctor. Your specific recommendation to get a flu vaccine each and every year is the best way to convince your patients to be immunized.
- • Immunize all medical office staff with the influenza vaccine annually at the beginning of flu season (October/November).
- • Screen every patient to determine if they should receive the influenza and/or pneumococcal vaccine
- • Ask every patient if they live or work with people in high-risk groups.
- • Provide a Vaccine Information Statement (VIS) for patients to read before they are vaccinated.
- • Use only true contraindications or precautions when deciding not to immunize. Contraindications include severe allergic reaction to a prior dose of the vaccine or to a component of the vaccine, or moderate to severe acute illness at the time of the visit. (Specific to influenza vaccine, an anaphylactic reaction to eggs is a contraindication. A history of Guillain-Barrè Syndrome should be considered a precaution to receiving influenza vaccine). Reschedule patients who are too ill to receive the vaccine when their condition improves.
- • Immunize every patient indicated with influenza and/or pneumococcal vaccine.
- • Document the vaccine(s) administered on the "Vaccine Administration Record for Adults" flow sheet, which should be kept in the patient's medical chart.
- • If your patient refuses vaccine, have them sign the "Refusal to Receive Vaccination" form to stress the importance your practice places on immunizing against influenza and pneumococcal disease. File the form in the patient's medical chart.
A template for implementing standing orders for Influenza and Pneumococcal Vaccine administration accompanies the primer sure to review the protocols with staff that will be covered by these orders, complete the form and keep on file in your medical office.
The "Refusal to Receive Vaccinations" form documents that a patient has rejected influenza or pneumococcal vaccine after a physician has recommended them. After the patient completes this form, place it in his or her medical chart. Using this form will help convey to patients the importance your practice places on flu and pneumococcal vaccines.
