Standing Orders

Standing orders authorize nurses and other trained health care professionals, where allowed by state law, to assess the need for vaccination and to administer vaccinations according to a protocol approved by a physician, institution or authorized practitioner. Standing orders work by enabling assessment and vaccination of the patient without the need for clinician examination or direct order from the attending provider at the time of the interaction. Standing orders have been shown to increase vaccination coverage rates.  Vaccine standing orders are updated as needed and reviewed for technical accuracy by immunization experts at CDC. The most current versions can be accessed by going to

Take A Stand™

Take A Stand™ is a new national initiative from the Immunization Action Coalition (IAC) to assist medical practices with implementation of standing orders for adult vaccines. IAC through a sponsorship from Pfizer has developed the Take A Stand™ Workshop training and education program. ACOG urges participation in these free Workshops designed to help practices easily implement SOPs for adult vaccinations.

Adult immunization rates in the United States are dreadfully low resulting in increased mortality and morbidity. Strong evidence supports the use of Standing Orders Programs (SOPs) to improve immunization rates in the adult population. Their use is recommended by numerous public health organizations, federal agencies, and provider associations, but unfortunately, standing orders are not being adequately utilized for adult immunizations.

Free educational half day workshops provided for physician practices around the country form the heart of the Take A Stand™ project. Speakers at specific workshops may vary, but the multi-disciplinary team will include national experts such as L.J Tan, MS PhD, IAC Chief Strategy Officer; William Atkinson, MD MPH, IAC Associate Director for Immunization Education; Deborah Wexler, MD, IAC Executive Director; and Alexandra Stewart, JD, Assistant Professor, Department of Health Policy, Milken Institute, School of Public Health, George Washington University. IAC is offering a year of free, direct support to assist practices implement standing orders following their attendance at the workshop.

Workshops began in October and November 2015, and 17 additional workshops will take place during the first half of 2016. Successful implementation of SOPs will improve the quality of patient care by improving adult immunization rates in medical practices. SOPs will also reduce the logistical burdens of providing adult vaccines while improving the operational efficiency of clinician practice.

More information on Take A Stand™ and registration for these Workshops is available at:

TakeaStand Upcoming Workshops: TakeaStand Workshops from March- June 2016

Articles on the Efficacy of Standing Orders

Use of standing orders programs to increase adult vaccination rates. McKibben LJ, Stange PV, Sneller VP, Strikas RA, Rodewald LE; Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2000 March 24;49(RR-1):15-6. Review.

Cost-effectiveness of pneumococcal and influenza vaccination standing order programs. Lin CJ, Zimmerman RK, Smith KJ. Am J Manag Care. 2013 January 1;19(1):e30-7.

Improving pneumococcal vaccine rates. Nurse protocols versus clinical reminders. Rhew DC, Glassman PA, Goetz MB. J Gen Intern Med. 1999 June;14(6):351-6.

Effectiveness of hospital-based postpartum procedures on pertussis vaccination among postpartum women. Yeh S, Mink C, Kim M, Naylor S, Zangwill KM, Allred NJ. Am J Obstet Gynecol. 2014 Mar;210(3):237.e1-6. doi:10.1016/j.ajog.2013.09.043. Epub 2013 Oct 2.

Implementation and evaluation of a nursing assessment/standing orders-based inpatient pneumococcal vaccination program. Eckrode C, Church N, English WJ 3rd. Am J Infect Control. 2007 Oct;35(8):508-15.

Designing and implementing a hospital-based vaccine standing orders program. Sokos DR, Skledar SJ, Ervin KA, Nowalk MP, Zimmerman RK, Fox DE, Middleton DB. Am J Health Syst Pharm. 2007 May 15;64(10):1096-102.

Cost-effectiveness of hospital vaccination programs in North Carolina. Honeycutt AA, Coleman MS, Anderson WL, Wirth KE. Vaccine. 2007 Feb 9;25(8):1484-96. Epub 2006 Nov 10.

Hospital-based strategies for improving influenza vaccination rates. Crouse BJ, Nichol K, Peterson DC, Grimm MB. J Fam Pract. 1994 Mar;38(3):258-61.



 Updated 12/1/15


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