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Improving On-time Administration of the Initial Hepatitis B Vaccine in the NICU
Michelle M Gontasz1, Bethany S Chalk2, Caroline Liang3
1From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Delays in hepatitis B vaccine (birth dose) administration are common in Neonatal Intensive Care Units (NICUs). Quality improvement methods increased on-time vaccination rates, improving infant health outcomes.
Area of Science:
- Neonatal care
- Vaccinology
- Public Health
Background:
- Delays in hepatitis B vaccine birth dose administration are frequent in Neonatal Intensive Care Units (NICUs), despite American Academy of Pediatrics recommendations.
- Such delays increase risks of perinatal hepatitis B infection and subsequent childhood immunization delays.
Purpose of the Study:
- To improve the on-time administration of the hepatitis B vaccine birth dose in a level III and level IV NICU.
- The target was to increase on-time administration from 46% to at least 70%.
Main Methods:
- Quality improvement methods were employed, including developing unit guidelines and progress note prompts.
- On-time administration of the hepatitis B vaccine birth dose for NICU infants born to hepatitis B-negative mothers was the primary outcome measure.
- Statistical process control P-charts tracked changes from January 2019 to May 2021.
Main Results:
- A total of 2192 patients were analyzed.
- The percentage of on-time hepatitis B vaccine administration improved from 48% to 57%.
- The rate of on-time administration or a valid reason for delay increased from 76% to 80%.
Conclusions:
- Quality improvement initiatives successfully identified and addressed barriers to timely hepatitis B prophylaxis in the NICU.
- Tailored guidelines and electronic health record modifications led to sustained improvements in vaccine administration timeliness.
- These strategies may be beneficial for other NICUs seeking to enhance immunization rates.
Introduction:
Despite the updated American Academy of Pediatrics recommendation for universal administration of the hepatitis B vaccine for newborns, delays in routine prophylaxis are common in the Neonatal Intensive Care Unit (NICU). Delayed immunization can increase perinatal acquisition risks and lead to subsequent delays in routine childhood immunization. This study aimed to increase the on-time administration of the birth dose of the hepatitis B vaccine from 46% to ≥70% at a level III and level IV NICU within the same health system.
Methods:
The stakeholder group developed project interventions using quality improvement methods, including implementing unit guidelines and a prompt in the progress note template. The outcome measure was the percent on-time administration of the initial hepatitis B vaccine for inborn NICU patients born to hepatitis B-negative mothers. The process measure was the percent on-time administration or a valid reason to delay immunization following the guidelines. Statistical process control P-charts graphically represented the measures to assess for change from January 2019 to May 2021.
Results:
In total, 2192 patients were included. The percent on-time administration improved from 48% to 57%. The percentage of on-time administration or valid reason to delay increased from 76% to 80%.
Conclusions:
Quality improvement methodology facilitated the identification of barriers to on-time hepatitis B prophylaxis in the NICU and the improvement of the timeliness of administration across 2 sites. Guidelines tailored to this population and changes to the progress note template successfully created and sustained change and may benefit other NICUs.
