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ACIP Recommends Standing Orders Programs

ATLANTA, GA-According to the Morbidity and Mortality Weekly Report (MMWR) published March 24, 2000, the Advisory Committee on Immunization Practices (ACIP) recommends that standing orders programs be implemented in long-term-care facilities under the supervision of the medical director and committee guided protocols. Standing orders programs allow nurse- or pharmacist-issued vaccinations to adults without a physician's exam. Each institution that plans to implement standing orders programs should utilize a committee to establish program guidelines and procedures. ACIP recommends protocols be written for the following procedures:

1. Identifying persons eligible for a vaccine based on their age, vaccination status, or presence of a medical condition that puts them at high risk.

2. Providing information to patients or their guardians regarding the risks and benefits of a vaccine.

3. Recording patient refusals or medical contraindications.

4. Recording vaccination and any post vaccination adverse events.

5. Providing documentation of vaccination to patients and their primary-care providers.

The Centers for Disease Control and Prevention (CDC) report that approximately 550,000 cases per year are pneumococcal-disease related and the bacteria is responsible for more deaths than any other vaccine-preventable bacterial disease. Hence, ACIP recommends focusing on influenza and pneumococcal vaccinations and implementing programs with hepatitis B and diphtheria and tetanus toxoid vaccines when possible. ACIP also suggests the implementation of standing orders programs in inpatient and outpatient facilities, managed-care organizations, assisted living facilities, correctional facilities, pharmacies, adult workplaces, and home healthcare agencies.

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