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

Area of Science:

• Public Health
• Pediatrics
• Quality Improvement Science

Background:

• The New York State Department of Health mandates the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term infants.
• Current adherence rates to this recommendation require improvement to ensure timely infant protection against hepatitis B.
• Maternal hepatitis B status should not be a barrier to timely vaccine administration.

Purpose of the Study:

• To enhance the timeliness of hepatitis B vaccine birth dose administration within 12 HOL.
• To increase the overall percentage of infants receiving the hepatitis B vaccine before hospital discharge.
• To assess the sustainability of improvements achieved through quality improvement initiatives.

Main Methods:

• Utilized multiple Plan-Do-Study-Act (PDSA) cycles to drive process changes.
• Employed statistical process control charts with 3-sigma control limits to monitor vaccination rates.
• Adjusted control limits over time to reflect and sustain performance improvements.

Main Results:

• Vaccination rates within 12 HOL increased from 13% to over 65% within six months.
• Sustained improvements in timely vaccination (within 12 HOL) were observed for over one year.
• Vaccine administration prior to discharge rose from 94% to 98%.

Conclusions:

• Quality improvement methodologies can effectively and rapidly enhance adherence to newborn vaccination guidelines.
• The observed improvements in hepatitis B vaccine administration timeliness and completeness are sustainable.
• These findings support the widespread adoption of PDSA cycles in healthcare settings to improve public health recommendations.