Improving Timeliness of Hepatitis B Vaccine Birth Dose Administration

Area of Science:

• Neonatal care
• Vaccinology
• Public health interventions

Background:

• Hepatitis B vaccine is highly effective (up to 90%) in preventing perinatal infection when administered within 24 hours of birth.
• The American Academy of Pediatrics recommends timely vaccination for eligible newborns, but national compliance benchmarks are lacking.
• Current compliance rates for timely hepatitis B vaccine birth dose are suboptimal, necessitating quality improvement initiatives.

Purpose of the Study:

• To increase the monthly average of eligible newborns receiving the hepatitis B vaccine birth dose within 24 hours from 40% to a target of 80% over a 9-month period.
• To establish a benchmark for timely hepatitis B vaccine administration in a neonatal setting.

Main Methods:

• Implementation of a series of plan-do-study-act cycles in a level 1 nursery.
• Interventions focused on staff education, nurse-driven consent and vaccine ordering, and earlier nursing assessments.
• Utilized statistical process control to monitor the primary outcome (monthly percentage of timely vaccinations) and secondary outcome (nonvaccination events).

Main Results:

• Mean monthly rate of hepatitis B vaccine administration within 24 hours increased significantly from 40% to 92%.
• The rate of predischarge vaccination improved substantially, with cases increasing from a mean of 13 to 61.
• Demonstrated a marked reduction in delays for vaccine administration.

Conclusions:

• Nurse-led interventions, specifically obtaining consent and integrating the vaccine into nurse-activated order sets, were key drivers of improved timeliness.
• Achieved a compliance rate of 92%, exceeding the initial goal and establishing a potential benchmark for other institutions.
• Highlights the effectiveness of empowering nursing staff in quality improvement initiatives for timely vaccination delivery.