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Improving Palivizumab Administration to High-Risk Infants with Heart Disease via a Communication-Based Quality
David M Leone1, Alexis Rodriguez2, Kirsten Cowenhoven1
1Section of Pediatric Cardiology, Yale University School of Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA.
Insights
Improving palivizumab administration for high-risk infants with congenital heart disease is crucial. Interventions significantly increased monthly palivizumab doses, enhancing care for vulnerable pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- High-risk infants, particularly those with congenital heart disease, require timely palivizumab for respiratory syncytial virus (RSV) prevention.
- Achieving optimal palivizumab administration rates is challenging in academic children's heart centers.
- A multidisciplinary approach is essential for improving medication adherence in pediatric populations.
Purpose of the Study:
- To enhance palivizumab administration to 80% in high-risk infants with congenital heart disease over two years.
- To evaluate the impact of communication and documentation interventions on palivizumab adherence.
- To establish a sustainable system for identifying and tracking eligible infants for palivizumab therapy.
Main Methods:
- A prospective study was conducted at an academic children's heart center.
- Interventions included improved identification and tracking of eligible pediatric cardiac patients (n=114) for palivizumab.
- Data on palivizumab doses administered were collected via the electronic health record over two years.
Main Results:
- The monthly palivizumab administration rate increased significantly from 57.6% to 78.4% (p=0.02).
- The percentage of infants receiving at least 80% of eligible doses rose from 42.1% to 60%, though not statistically significant (p=0.20).
- Interventions effectively improved the identification and tracking of eligible infants, leading to increased administration rates.
Conclusions:
- Targeted interventions focusing on infant identification and tracking significantly improved palivizumab administration rates.
- Continued quality improvement efforts are necessary to reach and sustain the 80% target for palivizumab administration.
- Optimizing palivizumab use is vital for preventing RSV in high-risk pediatric cardiac patients.
Abstract:
To improve palivizumab administration in high-risk infants with congenital heart disease to 80% over 2 years at an academic children's heart center. A multidisciplinary team at our institution implemented a series of interventions over a 2-year prior. Pediatric cardiac patients were identified for palivizumab eligibility, and a baseline rate of administration was obtained. A series of communication and documentation-based interventions were implemented over the course of the next 2 years. Palivizumab eligible infants (n = 114) were determined based on guidelines after review of diagnosis code, oxygen saturation, and medications. Doses of palivizumab were tracked via the electronic health record. The primary outcome measures were the rate of monthly palivizumab doses administered per the number of eligible months and the percentage of infants who received at least 80% of eligible doses during the respiratory syncytial virus season. The rate of monthly palivizumab doses increased from 57.6% during the baseline period to 78.4% during the final year of the project (p = 0.02). The percentage of infants who received 80% of eligible doses increased from 42.1 to 60% but was not statistically significant (p = 0.20). Interventions focused on properly identifying and tracking infants eligible for palivizumab treatment significantly increased the rates of administration.
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