Background Infants hospitalized in neonatal intensive care units for a prolonged period of time are at risk for not being immunized against vaccine preventable diseases per guidelines outlined by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. The guidelines recommend that premature infants receive routine childhood vaccines at chronologic age versus corrected gestational age. Multiple studies completed in the United States, Europe and Canada demonstrated that these patients lag behind their term gestation peers in receiving their vaccines in a timely manner. This delay places them at risk for acquiring these diseases, and requiring primary care providers caring for these babies after discharge to determine “catch-up” schedules to ensure up to date vaccine status.

Local Problem Data collected from a chart review completed prior to the initiation of the implementation plan revealed an on time immunization rate of 60%. The chart review did not reveal reasons for delay.

Intervention This quality improvement project evaluated the use of a best practices alert in the electronic medical record to improve on-time administration of two month vaccines (within 60-70 days of age) or documentation reflecting specific reason for deferral. The project was conducted in a 52 bed, Level IV academic neonatal intensive care unit in the Mid-Atlantic region. Inclusion criteria included all patients hospitalized in the neonatal intensive care unit and two months of age. A query was submitted to the institution’s Investigational Review Board, and determined to be non-human subjects research.

Prior to implementation of the best practices alert, a survey was developed and distributed to neonatal intensive care unit nurses and providers to establish baseline knowledge, attitudes and beliefs regarding immunization practices. The findings of the survey were used to develop and provide education sessions providing clarification of immunization requirements and practices.
The education sessions also introduced the use of the best practice alert. A best practices alert was developed and placed into the electronic medical record to remind providers beginning on the infant’s day of life 55 that two-month immunizations were due. The best practices alert provided guidance to providers to discuss immunizations with the parent/guardian and also provided a link to an order set within the electronic medical record to the vaccine products.

Results Simple descriptive data of the proportion of patients receiving vaccines on time was collected prior to the use of the best practice alert to establish a baseline rate of on-time administration of vaccines. Post-implementation of the best practices alert, data collected via chart audits over the next 13 weeks revealed an on-time administration rate (or documentation of specific reason for deferral) of 83%.
Conclusion A best practices alert, along with education, is a useful tool for improving vaccination rates in a Level IV neonatal unit. The results of this project showed an increase of on-time immunization from a rate of 60% immediately pre-implementation of the best practices alert to 85% during the project implementation period.