Evaluation of a toolkit to introduce standing orders for influenza and pneumococcal vaccination in adults: A multimodal pilot project

► The standing order program (SOP) toolkit was accepted by most, but buy-in, motivation and maintenance were barriers. ► Less highly trained clinical staff were less willing to adopt SOPs for adult immunizations. ► Lower SOP toolkit acceptance was associated with immunization rates no different from the control site's rates. ► Toolkits that only address SOPs to administer influenza vaccine have no effect on patients not seen during influenza vaccination season. ► The revised 4 pillars SOP toolkit stresses access, communication, enhanced systems and motivation.