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. 2021 Dec 1:hpeds.2021-005969.
doi: 10.1542/hpeds.2021-005969. Online ahead of print.

Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy

Allene Pulsifer  1   2 , Karen M Puopolo  1   3   4 , Lauren Skerritt  5 , Miren B Dhudasia  1   3 , Beth Ann Pyle  2 , Aida Schumacher  2 , Sagori Mukhopadhyay  1   3   4
Affiliations

Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy

Allene Pulsifer et al. Hosp Pediatr. .

Abstract

Background: In September 2017, the American Academy of Pediatrics issued guidance recommending hepatitis B vaccine be administered to well newborns with birth weight ≥2000 g within 24 hours after birth. At that time, ∼85% of well newborns were vaccinated before discharge at our center; however, only 35% were vaccinated within 24 hours after birth. Our aim was to vaccinate 70% of eligible newborns within 24 hours after birth by June 2018 while maintaining the overall rate of vaccination.

Methods: A multidisciplinary improvement team analyzed existing vaccine administration processes in the well-newborn nursery. From October 2017 to January 2018, changes were made to activation of vaccine orders and to obtaining and documenting the consent processes. Vaccine administration was bundled with routine care given ≤24 hours after birth, and parent scripting was changed from offering vaccine as an option to stating it as a recommendation. From November 2016 to June 2019, we determined the overall rate and timing of vaccination using statistical process control methods.

Results: Among 10 887 eligible infants, the proportion administered hepatitis B vaccine ≤24 hours after birth increased from 35.5% to 78.8% after process changes with special-cause variation on process control charts. Proportion of infants receiving vaccine any time before discharge also increased from 86.5% to 92.3%.

Conclusions: Specific process changes allowed our birth center to comply with the recommended timing for hepatitis B vaccination of ≤24 hours after birth among eligible newborns.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.. Key Driver Diagram
The key driver diagram shows the main drivers of ideas that changed to accomplish the aim of administering hepatitis B vaccine to well newborns within 24 hours after birth. VIS, Vaccine Information Statement; EMR, electronic medical record. Created in Lucidchart, www.lucidchart.com.
Figure 2.
Figure 2.. Increased hepatitis B vaccination rates within 24 hours after birth
This p-chart shows the mean proportion (bound by upper and low confidence intervals) of well newborns administered hepatitis B vaccine within 24 hours after birth (Y-axis) over time (X-axis). Changes in practice are annotated. LCL, lower confidence limit; UCL, upper confidence limit.
Figure 3.
Figure 3.. Increased hepatitis B vaccinations rates prior to discharge
This p-chart shows the mean proportion (bound by upper and low confidence intervals) of well newborns administered hepatitis B vaccine prior to hospital discharge (Y-axis) over time (X-axis). Changes in practice are annotated. LCL, lower confidence limit; UCL, upper confidence limit.
See this image and copyright information in PMC

References

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