Influenza and pneumococcal vaccines are underused for persons in the United States aged > or = 65 years (66% receive influenza vaccine and 55% pneumococcal vaccine), even among patients in nursing homes (68% for influenza and 38% for pneumococcal vaccine). Systematic literature reviews by the Task Force on Community Preventive Services and the Southern California Evidence-Based Practice Center-RAND have shown that standing orders programs improve vaccination rates. Standing orders programs authorize nurses and pharmacists, where allowed by state law, to administer vaccinations according to an institution- or physician-approved protocol without the need for a physician's examination or direct order. Several studies have shown improved influenza and pneumococcal vaccination rates through standing orders programs specifically in long-term care facilities (LTCFs) and hospitals. Based on the strength of available evidence, the Advisory Committee on Immunization Practices recommends the use of standing orders programs in both outpatient and inpatient settings.