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A Standing Order in a General Medicine Clinic

Karen L. Margolis, MD; Richard P. Lofgren, MD; Jane E. Korn, MD

Arch Intern Med. 1988;148(10):2205-2207.

Abstract
• Educational programs designed to modify physician compliance with influenza vaccination guidelines have yielded only modest improvement. We examined the impact of a standing order on the influenza vaccination rate in a general medicine clinic (GMC). The standing order gave GMC nurses the responsibility to identify and vaccinate high-risk elderly patients. The vaccine order rate in GMC patients seen during the one-month study period in 1986 (n = 97) was compared with the rate in GMC patients from a similar period in 1984 (n = 77) and with the rate in patients seen in three subspecialty clinics during the 1986 study period (n = 106). Comparison patients were vaccinated only by specific physician order. Following the intervention, 79 (81%) of 1986 GMC study patients had vaccination orders, vs 20 (28%) of the 1984 GMC comparison group and 31 (29%) of the 1986 subspecialty clinic comparison group. A simple organizational change consisting of a standing order profoundly improved compliance with vaccination guidelines.

(Arch Intern Med 1988;148:2205-2207)

Author Affiliations
From the Department of Medicine, Section of General Internal Medicine, Minneapolis Veterans Administration Medical Center, University of Minnesota. Dr Margolis is now with the Department of Medicine, Hennepin County Medical Center, Minneapolis.

Footnotes
Accepted for publication July 7, 1988.

Presented in part at the Midwest Section of the American Federation of Clinical Research, Chicago, Nov 13, 1987.

Reprint requests to Department of Medicine, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN 55415 (Dr Margolis).

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