Effect of Revised Nursery Orders on Newborn Preventive Services

Madlon-Kay, Diane J.

doi:10.3122/jabfm.2011.06.110027

Cited by 4 publications

(1 citation statement)

References 13 publications

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“… 7 Similarly, Madlon-Kay found that a change in the way the vaccine was ordered was associated with an increase in newborns receiving the hepatitis B vaccine prior to nursery discharge. 8 These projects demonstrate how efforts to improve rates and timing of administration of the birth dose of hepatitis B vaccine are amenable to a QI approach to improve care.…”

Section: Introductionmentioning

confidence: 99%

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

et al. 2021

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Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal for rate of administration.In response to updated Advisory Committee on Immunisation Practices recommendations to administer the dose within 24 hours of birth, we used quality improvement methodology to implement changes that would increase the vaccination rates of healthy newborns in our nurseries. The goal was to improve the proportion of infants who receive the hepatitis B vaccine within 24 hours of birth to >90% within a 2-year period, with a secondary goal of increasing vaccination rates prior to discharge from the nursery to >95%.Multiple Plan–Do–Study–Act (PDSA) cycles were performed. Initial cycles focused on increasing nurse and provider awareness of the updated timing recommendations. Later cycles targeted nursing workflow to facilitate timely administration of the vaccine. We implemented changes at our university medical centre and community hospital newborn nurseries.At the university medical centre nursery, both primary and secondary goals were met; the rate of hepatitis B vaccine administration within 24 hours increased from 81.7% to 96.2%, with vaccine administration prior to discharge increasing from 93.4% to 97.9%. In the community hospital nursery, the baseline rate of hepatitis B vaccine administration within 24 hours was 78.1%, and this increased to 85.8% with the interventions, falling short of the target of >90%. Vaccine administration prior to discharge increased from 87.2% to 92.0%, also not meeting the secondary target of 95%.Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery.

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Section: Introductionmentioning

confidence: 99%

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

et al. 2021

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Hepatitis B birth dose vaccination patterns in the Military Health System, 2014–2018

Deerin

Clifton

Elmi

et al. 2021

Vaccine

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Change, Lack of Change, and Creating Optimal Change Out of Chaos

Bowman¹,

Neale²

2011

The Journal of the American Board of Family Medicine

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Once again, we consider how to effect practice change at the local and national levels. This issue includes several articles that relate to quality improvement. Some physician actions seem resistant to change, as do the underlying social determinants and processes that lead to what are thought to be avoidable hospitalizations, but we also find that concerted effort, along with standardized orders sets and other avenues, can make a difference. Sometimes, however, our attempts at change can lead to more distraction then efficacy. Here we include articles that place the quality issues in context, report interventions, and advance the types of specific knowledge that allow interventional trials. We also have several articles about cancer screening and follow-up, a subset of quality improvement. Quality ImprovementBaird 1 provides us with a fascinating historic and nuanced reflection of how and whether medical homes represent something new or otherwise different from former attempts at reform in family medicine, specifically managed care. In light of previous inflated expectations of the ways in which reforms can change medical care, he says, "no villains allowed."Information chaos is clearly one of the reasons that we struggle to improve quality to a desired level. Beasley and colleagues 2 provide a structure to consider the information chaos, the negative outcomes of the chaos, and some direction for future research. This construct also relates to our tonguein-cheek, yet provocative, selection from Baxley et al.3 who suggests that we sometimes act as if we have attention deficit disorder as we attempt to implement multiple concurrent Plan-Do-StudyAct practice improvement projects. It is a variant of a "quality improvement disorder." Therefore, some remedies are in order. However, the answer is not to just take a pill daily and hope it will go away. Hopefully, we can improve the quality of our quality improvement activities.In one major attempt to improve health care nationally, the Affordable Care Act mandates that the Centers for Medicaid and Medicare Services (CMS) implement a 10% payment increase for primary care. CMS criteria defining primary care are unfortunately currently inadequate to the task because they exclude many family physicians, particularly those in more rural settings or those who provide a broader range of services, as documented by research from the Robert Graham Center. 4 On to specific examples from the articles in this issue. We know that preventable hospitalizations vary by location, but just how easy are these to avert? Sumner et al 5 determined that the differences in preventable hospitalizations between the counties in Kentucky persisted over time. This suggests that underlying problems or processes are not readily changed, and that needed health care improvements will be relatively resistant to transformation.Another specific quality improvement item that seems resistant to change is the ordering of urine cultures for women with urinary tract infection symptoms. Obtaining urine culture...

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Effect of Revised Nursery Orders on Newborn Preventive Services

Cited by 4 publications

References 13 publications

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

Hepatitis B birth dose vaccination patterns in the Military Health System, 2014–2018

Change, Lack of Change, and Creating Optimal Change Out of Chaos

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