Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative

Nemerofsky, Sheri L.; Akingboye, Bolanle; Ferguson, Claudia; Africa, Dawn

doi:10.1177/1062860617732635

Cited by 12 publications

(9 citation statements)

References 8 publications

(9 reference statements)

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“…Given these data, strategies to increase administration during hospitalization are needed. Recent quality improvement studies using approaches such as standardization of HepB vaccination processes and greater education of parents, nurses, and providers, markedly improved HepB vaccination of healthy newborns ≥2,000 g before hospital discharge 32 33 ; similar interventions could be considered for these high-risk infants under 2,000 g.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis B Vaccination of Low Birth Weight Infants in Washington State

Ost¹,

Oster

Jacobson

et al. 2020

Am J Perinatol

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Objective The U.S. Advisory Committee on Immunization Practices (ACIP) recommends that infants born weighing less than 2,000 g receive the hepatitis B (HepB) vaccine at hospital discharge or 30 days of age. This study aimed to assess timely HepB vaccination among low birth weight infants. We hypothesized that many of these vulnerable infants would fail to receive their HepB birth dose on time. Study Design This retrospective cohort study included Washington State infants born weighing less than 2,000 g at an academic medical center between 2008 and 2013. Data were abstracted from electronic health records and linked to vaccine data from the Washington State Immunization Information System. Multivariable logistic regression was used to examine the associations between sociodemographic, clinical, and visit characteristics and HepB vaccination by birth hospitalization discharge or 30 days of age. Results Among 976 study infants, 58.4% received their HepB vaccine by birth hospitalization discharge or 30 days of age. Infants had higher odds of timely HepB vaccination if they were Hispanic (adjusted odds ratio [AOR] = 1.80, 95% confidence interval [CI]: 1.10–2.95) or non-Hispanic black (AOR = 2.28, 95% CI: 1.36–3.80) versus non-Hispanic white or if they were hospitalized 14 days or longer versus less than 14 days (AOR = 2.43, 95% CI: 1.66–3.54). Infants had lower odds of timely HepB vaccination if they were born before 34 weeks versus on or after 34 weeks of gestational age (AOR = 0.41, 95% CI: 0.27–0.63) or if they had an estimated household income less than $50,845 versus 50,845 or greater (AOR = 0.64, 95% CI: 0.48–0.86). Conclusion Many infants born weighing less than 2,000 g did not receive their first HepB birth dose according to ACIP recommendations. Strategies are needed to improve timely HepB vaccination in this high-risk population. Key Points

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Section: Discussionmentioning

confidence: 99%

Hepatitis B Vaccination of Low Birth Weight Infants in Washington State

Ost¹,

Oster

Jacobson

et al. 2020

Am J Perinatol

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“…A quality improvement intervention in an urban hospital with high HBV prevalence serving a diverse, largely immigrant and socioeconomically disadvantaged population significantly increased HepB vaccination rates at 12 hours of life with the addition of a standing order for HepB vaccine at birth in addition to physician and nurse education. 13 Contrary to our setting, we had persistent low HepB vaccination rates despite the standing order. The perceived lack of risk of transmission combined with low prevalence was a key barrier to urgency and HepB vaccine receipt before discharge.…”

Section: Discussionmentioning

confidence: 57%

“…Interventions that improve HepB vaccine birth dose rates include standing orders and the codification of a hospital birth dose policy. [11][12][13] Furthermore, enhancements in the vaccine ordering and delivery processes combined with staff education have resulted in improved vaccination rates for birth dose HepB vaccination as well as other vaccines administered in inpatient settings. [13][14][15][16] However, despite national and state recommendations, use of a standing order, and the presence of a hospital birth dose policy, our institutional MBU HepB vaccination birth dose rates were well below national and city averages.…”

mentioning

confidence: 99%

Improving Birth Dose Hepatitis B Vaccination Rates: A Quality Improvement Intervention

Bradshaw¹,

DiFrisco

Schweizer

et al. 2020

Hospital Pediatrics

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BACKGROUND: There are 43 000 new cases of hepatitis B virus infection and 1000 cases of perinatally acquired infection each year in the United States. National recommendations are to administer hepatitis B (HepB) vaccine to all stable newborns .2000 g within 24 hours of birth. Our primary objective was to increase institutional vaccination rates from a baseline of 52% to goal .85% before hospital discharge. METHODS:In February 2017, we instituted a multidisciplinary quality improvement project aimed at increasing HepB vaccination birth dose rates. Interventions included (1) standardizing the process of offering HepB vaccine via scripting and timing, (2) engaging and educating parents, and (3) educating physicians and nurses regarding the importance of HepB vaccination and strategies to discuss HepB vaccination with vaccine-hesitant parents. The main outcome measure was the percentage of newborns receiving HepB vaccination by discharge. The secondary outcome was the percentage of newborns receiving HepB vaccination by 12 hours of life per New York State Department of Health recommendation. Data were analyzed by using statistical process control P-charts.RESULTS: A total of 21 108 newborns were included between July 2015 and April 2019. In addition to several upward centerline shifts, implementation of interventions resulted in increased and sustained HepB vaccination rates by hospital discharge from a baseline of 52.4% to 72.5%. Rates by 12 hours of life increased from 21.5% to 42.5%. CONCLUSIONS:Multidisciplinary collaboration, scripting, and provider and staff education regarding the risks of hepatitis B virus, benefits of HepB vaccine, and strategies to discuss HepB vaccination with parents significantly increased vaccination rates. Further efforts to improve vaccination rates to within 12 hours are preferable.

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“…Interventions that improved workflow provided additional improvement beyond education alone, similar to findings documented by Nemerofsky et al in their QI efforts to improve timing of the birth dose of hepatitis B vaccine. 7 The improvement in timing of administration has been sustained over a several month period and would be expected to be sustainable long term given that it is based on permanent changes to nursing workflow. Given that our interventions achieved improvements in both a university medical centre and a community hospital nursery setting, we anticipate that other nurseries would be able to use similar interventions to improve rates and timing of vaccine administration.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Nemerofsky et al found most improvement when they addressed workflow by adding the vaccine order to a standard newborn admission order set. 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: 98%

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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Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative

Cited by 12 publications

References 8 publications

Hepatitis B Vaccination of Low Birth Weight Infants in Washington State

Hepatitis B Vaccination of Low Birth Weight Infants in Washington State

Improving Birth Dose Hepatitis B Vaccination Rates: A Quality Improvement Intervention

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

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