Improving Infant Vaccination Status in a Level IV Neonatal Intensive Care Unit

Abstract

BACKGROUND AND OBJECTIVES: Infants in NICUs are at risk for underimmunization. Adherence to the routine immunization schedule recommended by the Advisory Committee for Immunization Practices minimizes the risk of contracting vaccine-preventable illnesses in this vulnerable population. From January 2015 to June 2017, only 56% (419 of 754) of the infants in our Mayo Clinic level IV NICU were fully up to date for recommended immunizations at the time of discharge or hospital unit transfer. We aimed to increase this rate to 80% within 6 months. METHODS: Using the quality improvement methodology of Define, Measure, Analyze, Improve, Control, we analyzed baseline data, including provider and nursing surveys using a fishbone diagram, the 5 Whys, and a Pareto chart. We identified 3 major root causes of the quality gap: lack of provider knowledge of the routine immunization schedule, failure of providers to order vaccines when due, and hesitancy of parents toward vaccination. Using plan-do-studyact cycles, 5 improvement interventions were implemented. These included an intranet resource for NICU providers on the routine immunization schedule, an Excel-based checklist to track when immunizations were due, and provider education on parental vaccine hesitancy and vaccine safety. RESULTS: During the 19-month improve and control phases of the project, the fully immunized rate at the time of NICU discharge or transfer rose from a baseline of 56% (419 of 754) to 93% (453 of 488), with a P value ,.001. CONCLUSIONS: Our NICU significantly improved infant immunization rates with a small number of interventions. These interventions may be generalizable to other NICUs with low infant immunization rates.

A Improving Birth-dose Hepatitis-B Vaccination in a Tertiary Level IV Neonatal Intensive Care Unit

“…To address the challenge of obtaining parental consent for the birth dose HBV immunization, we made changes to our immunization policy that aimed to empower nurses to play a more active role in this process. Published data 9,12,19,20 corroborates this approach in achieving success. As part of these interventions, nurses were educated and encouraged to take the initiative to obtain parental consent within 12 hours before the end of their shift.…”

Vaccine Administration in Children’s Hospitals

“…Children in the NICU are at risk for undervaccination, and there may be hospital-level policies related to vaccinations for this population. 26,[35][36][37][38][39] We examined the demographic, clinical, and hospital visit characteristics associated with administration of $1 noninfluenza, nonbirth dose hepatitis B vaccine dose in children $2 months of age at the time of hospitalization.…”