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Improvement in Palivizumab Administration Prior to Discharge for Hospitalized Infants with Hemodynamically

Andrea L Jones1, Matthew J Campbell2, Brittany Abernathy3

  • 1Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. jonesa21@chop.edu.

Pediatric Cardiology
|May 5, 2023
PubMed

Insights

This quality improvement initiative significantly increased palivizumab adherence for infants with congenital heart disease. Interventions improved guideline adherence, ensuring more eligible infants received respiratory syncytial virus (RSV) immunoprophylaxis.

Area of Science:

  • Pediatric Cardiology
  • Infectious Disease Prevention
  • Healthcare Quality Improvement

Background:

  • Infants with hemodynamically significant congenital heart disease are at high risk for severe respiratory syncytial virus (RSV) infections.
  • Palivizumab administration guidelines aim to reduce RSV-related morbidity and mortality in these vulnerable infants.
  • Provider adherence to palivizumab guidelines can be suboptimal, necessitating targeted quality improvement efforts.

Purpose of the Study:

  • To enhance provider adherence to palivizumab administration guidelines for hospitalized infants with hemodynamically significant congenital heart disease.
  • To implement and evaluate interventions aimed at improving the appropriate use of palivizumab for RSV prophylaxis.
  • To assess the impact of interventions on palivizumab administration rates and inappropriate dosing.

Main Methods:

  • A quality improvement initiative was conducted over four RSV seasons, involving 470 infants.
  • Interventions included provider education, EMR template integration, pharmacy expert involvement, and alerts (text and EHR Best Practice Alert).
  • Outcome and process metrics tracked palivizumab administration rates, guideline adherence, and inappropriate dosing, analyzed using statistical process control.

Main Results:

  • Mean palivizumab adherence increased significantly from 70.1% at baseline to 97.9% by season 3.
  • Implementation of alerts (text and EHR BPA) correlated with improved adherence and appropriate "Need for RSV immunoprophylaxis" problem list entries.
  • The percentage of inappropriately administered palivizumab doses decreased from 5.7% at baseline to 0.0% in season 3.

Conclusions:

  • This multi-faceted quality improvement initiative successfully enhanced provider adherence to palivizumab administration guidelines.
  • The integrated interventions, particularly EHR alerts, proved effective in improving the appropriate use of palivizumab for high-risk infants.
  • Sustained improvements in palivizumab adherence can be achieved through targeted quality improvement strategies in pediatric healthcare settings.

Keywords:
Cardiac diseasePalivizumabProvider adherenceQuality improvementRespiratory syncytial virus infections

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