Improvement in Palivizumab Administration in Severely Immunocompromised Children: A Single-institution Quality
Diego R Hijano1,2, Delia C Allen3, Jonathan Burlison4
1From the Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tenn.
Insights
An institutional program significantly improved palivizumab adherence for immunocompromised children at high risk of respiratory syncytial virus (RSV) infection. This initiative enhanced prophylaxis without increasing severe RSV cases.
Area of Science:
- Pediatric Immunology
- Infectious Diseases
- Healthcare Management
Background:
- Palivizumab is crucial for reducing severe respiratory syncytial virus (RSV) infection risk in immunocompromised children.
- Existing guidance for palivizumab prophylaxis in this population has been vague, leading to inconsistent administration.
- An institutional program was developed to standardize palivizumab allocation for a defined high-risk group.
Purpose of the Study:
- To enhance provider adherence to palivizumab administration guidelines in profoundly immunocompromised children.
- To implement an educational program, identify clinical pharmacists, and inform primary providers about eligible patients.
- To analyze the impact of the program on guideline adherence and severe RSV infection rates.
Main Methods:
- The primary process metric was palivizumab guideline adherence, measured by the percentage of patients receiving all recommended monthly doses.
- A statistical process control P-chart analyzed the outcome metric before (2009-2013) and during (2014-2021) the intervention.
- Balancing metrics included inappropriate doses and severe RSV infections in non-eligible or non-treated patients.
Main Results:
- Over 8 RSV seasons, more than 80% of patients received all expected monthly palivizumab doses, with 89% of eligible doses administered.
- Guideline adherence increased from 30% to 99% by season 3 and remained above 95% thereafter.
- Inappropriate palivizumab use decreased to zero post-implementation, and no profoundly immunocompromised patients experienced severe RSV.
Conclusions:
- The developed institutional program successfully improved adherence to palivizumab administration guidelines for profoundly immunocompromised children.
- The intervention achieved high adherence rates over 8 consecutive RSV seasons.
- No increase in RSV infection incidence or severity was observed, demonstrating the program's safety and efficacy.
Introduction:
Palivizumab reduces severe respiratory syncytial virus (RSV) infection risk in immunocompromised children. However, guidance on palivizumab prophylaxis for immunocompromised children has remained vague. We developed an institutional program to allocate palivizumab in a predefined high-risk group of patients.
Methods:
We aimed to increase provider adherence to palivizumab administration in profoundly immunocompromised children through education, identifying clinical pharmacists, and informing primary providers of eligible patients. The primary process metric was palivizumab guideline adherence, indicated by the percentage of patients receiving all recommended doses each season. The primary metric was the percentage of eligible patients receiving monthly follow-up doses. Balancing metrics were the percentage of inappropriate doses and patients not meeting our definition of profoundly immunocompromised who did not receive palivizumab prophylaxis and had severe RSV infection. A statistical process control P-chart analyzed the outcome metric before program implementation (baseline: 2009-2013) and throughout interventions (seasons 1-8; 2014-2021).
Results:
More than 80% of patients received all expected monthly doses, with 89% (584 of 656) of eligible monthly palivizumab doses administered over 8 RSV seasons. The percentage of eligible patients receiving all recommended palivizumab doses increased from 30% to 99% in season 3, remaining more than 95%. Before intervention, 21 patients received palivizumab without meeting criteria; this decreased to 4 during season 1 postimplementation and to 0 thereafter. No profoundly immunocompromised patients meeting the operational definition or receiving palivizumab experienced severe RSV.
Conclusions:
We improved adherence to palivizumab administration guidelines for profoundly immunocompromised children over 8 consecutive RSV seasons without increasing RSV infection incidence or severity.
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