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Effect of an Electronic Order Set on Newborn Hepatitis B Immunization Rates.

Daniel Pedersen1,2, Angelina Rodriguez1,2, Olu Oyesanmi3

  • 1Oak Hill Hospital, Brooksville, FL.

HCA Healthcare Journal of Medicine
|July 10, 2023
PubMed
Summary

Modifying electronic health records for newborn admissions significantly improved hepatitis B immunization rates. The hepatitis B vaccination rate for newborns rose from 9.5% to over 90% after implementing updated order sets.

Keywords:
electronic health recordshepatitis Bimmunizationimmunization schedulepediatricspublic healthquality improvement

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Healthcare Quality Improvement

Background:

  • Hepatitis B virus (HBV) infection poses significant global health risks, leading to morbidity and mortality.
  • While no definitive cure exists, widespread immunization is a key preventive strategy in the United States.
  • Updated 2018 Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) guidelines recommend timely HBV vaccination for newborns.

Purpose of the Study:

  • To assess the impact of electronic medical record (EMR) newborn admission order set modifications on hepatitis B immunization rates.
  • To align clinical practice with the latest ACIP/CDC recommendations for newborn HBV vaccination.
  • To evaluate the effectiveness of a quality improvement initiative in enhancing vaccination coverage.

Main Methods:

  • The EMR newborn admission order set was updated to incorporate current ACIP/CDC hepatitis B vaccination guidelines.
  • Hepatitis B immunization rates were retrospectively analyzed for a 12-month period before and after the EMR order set modification.
  • Data on immunization timing (within 24 hours of birth) and overall rates prior to hospital discharge were compared.

Main Results:

  • The overall hepatitis B immunization rate before hospital discharge increased dramatically from 9.5% to over 90% post-intervention.
  • The rate of HBV immunization within the first 24 hours of birth improved from 74.1% to 91.1%.
  • Enhanced accessibility of immunization records to outpatient providers was facilitated through a statewide immunization database.

Conclusions:

  • Modifying EMR order sets is a highly effective strategy for improving clinical ordering practices.
  • This quality improvement project demonstrates a significant positive impact on hepatitis B vaccination rates in newborns.
  • System-level changes in EMRs can lead to substantial advancements in public health initiatives like childhood immunization.