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Increasing Immunization Rates in Infants with Severe Chronic Lung Disease: A Quality Improvement Initiative
Beatriz Milet1,2, John Chuo3, Kathleen Nilan3
1Division of Neonatology, Department of Pediatrics, AtlantiCare Regional Medical Center Mainland Campus, Pomona, New Jersey.
Insights
Infant immunizations for chronic lung disease (CLD) patients in the NICU increased significantly through targeted rounds and multidisciplinary discussions. This initiative successfully boosted vaccination rates and improved timely record review for high-risk infants.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Public Health
Background:
- Infant chronic lung disease (CLD) is a serious complication of prematurity, increasing vulnerability to infections like pneumococcal disease, influenza, and bronchiolitis.
- Premature infants with CLD face higher risks of respiratory morbidity, rehospitalization, and mortality due to these infections.
- Ensuring timely immunizations is critical for protecting this high-risk population.
Purpose of the Study:
- To increase 2-, 4-, and 6-month immunization rates in eligible infants with CLD in the Neonatal Intensive Care Unit (NICU).
- To achieve a 30% increase in immunization rates by December 2016.
- To improve the timeliness of immunization record review for infants with CLD.
Main Methods:
- A multidisciplinary team implemented weekly targeted rounds to identify eligible infants with outstanding immunizations.
- Exclusion criteria were established to ensure patient safety, including oxygen requirements, clinical instability, and recent procedures.
- Key interventions included in-hospital immunization record review, email reminders, weekly eligibility discussions, and an updated rounding tool.
Main Results:
- The project involved 60 patients between March and December 2016.
- Immunization rates for eligible infants increased from 44% to 75% and were sustained for six months.
- The average time from admission to immunization record review decreased from 71 days to 27 days.
Conclusions:
- A multidisciplinary approach incorporating record review, reminders, and structured discussions effectively increased and sustained infant immunization rates.
- The implementation of an in-hospital immunization program proved successful for infants with CLD.
- Weekly multidisciplinary CLD meetings provided a valuable platform for discussing immunization eligibility and safety monitoring.
Objectives:
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.
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