Increasing Immunization Rates in Infants with Severe Chronic Lung Disease: A Quality Improvement Initiative

Abstract

A B S T R A C TOBJECTIVES: Immunizations provide important protection from serious childhood illnesses. Infant chronic lung disease (CLD) is a serious complication of prematurity and predisposes premature infants to respiratory morbidity, rehospitalization, and mortality. This high-risk group is especially vulnerable to infections, such as invasive pneumococcal disease, influenza, and bronchiolitis. Our purpose for this project was to increase 2-, 4-, and 6-month immunization rates in eligible infants with CLD in the NICU by 30% through December 2016. METHODS:A multidisciplinary team developed weekly targeted rounds to identify eligible patients with outstanding immunizations. Exclusion criteria included the following: (1) a fraction of inspired oxygen requirement of .80%, (2) pulmonary hypertensive crisis, (3) positive blood culture results or if within 48 hours of a sepsis evaluation, (4) if within 5 days of a surgical or interventional procedure, (5) receiving steroid treatment (not including a physiologic hydrocortisone dose for adrenal insufficiency), (6) a CLD team consensus of contraindication, and (7) parental refusal. RESULTS:The project managed 60 patients from March 2016 to December 2016. Immunization of eligible patients increased from 44% to 75% and was sustained for the next 6 months. The average number of days from admission to immunization record review decreased from 71 days at baseline to 27 days. CONCLUSIONS:The implementation of (1) an in-hospital immunization record review, (2) an e-mail reminder, (3) a weekly multidisciplinary eligibility discussion, and (4) an updated rounding tool was successful in increasing and sustaining immunization rates in this population of infants with CLD. The multidisciplinary CLD meeting was a novel opportunity to discuss immunization eligibility and safety monitoring.

Vaccination Status and Resource Use During Hospital Visits for Respiratory Illnesses

“…There has been increasing recognition of hospitalization as a missed opportunity to vaccinate children whose vaccination status is not UTD, particularly in the era of populationbased IISs, in which a child's vaccination status may be accessible to hospital-based providers. 19,[37][38][39][40] This study demonstrates that vaccination is relevant to hospitalbased pediatric care because we identified variation in diagnostic testing in the hospital by vaccination status. In areas with high rates of undervaccination, there may be spillover effects for resource use in hospitals and health systems because more children without UTD vaccination status will be seen in hospital care settings.…”

“…Hospital-based quality improvement efforts have shown improvement in vaccination rates for high-risk children who are hospitalized, and hospitals should continue to provide catch-up vaccinations during hospitalization when clinically appropriate. 37,38 One limitation of this study is the use of provider-documented vaccination status as our predictor variable rather than the child's actual vaccination status. Providerdocumented vaccination status is often inaccurate when compared with statewide vaccine registries.…”

Vaccination Status and Adherence to Quality Measures for Acute Respiratory Tract Illnesses

“…5,6,15,16 Hospital-based quality improvement efforts have revealed improvement in vaccination rates for high-risk children who are hospitalized. 4,30 In this study, we examined the association of documented vaccination status and adherence to quality indicators. Among variables that were measured, we were able to control for potential confounders of this association.…”

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

“…17 Immunization rates of infants with chronic lung disease were improved with implementation of regular immunization record review, implementation of rounding tools, and several other small improvement efforts. 18 Our project has limitations. Three of our interventions were introduced simultaneously, which makes it difficult to assess the impact of any single intervention.…”