Characteristics of long-term care facilities associated with standing order programs to deliver influenza and pneumococcal vaccinations to residents in 13 states

  • Shefer A
  • McKibben L
  • Bardenheier B
 et al. 
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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%. Objectives: 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. Design: Mailed survey. Setting: All Medicare- or Medicaid-licensed LTC Fs in 13 states. Participants: Directors of Nursing (DONs). Measurements: Survey collecting informationon 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 (

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  • Abigail Shefer

  • Linda McKibben

  • Barbara Bardenheier

  • Dale Bratzler

  • Henry Roberts

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