Jump start immunizations in NICU

MALMO, SWEDEN – The neonatal intensive care unit often represents a lost opportunity to bring an infant fully up to date for recommended age-appropriate immunizations – but it needn’t be that way, Raymond C. Stetson, MD, declared at the annual meeting of the European Society for Paediatric Infectious Diseases.

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He cited as a case in point the dramatic turnaround accomplished at the 26-bed NICU at the Mayo Clinic in Rochester, Minn., where he is a neonatal medicine fellow. When he and his coinvestigators conducted an electronic health record audit, they determined that only 56% of the 754 NICU patients cared for from 2015 through mid-2017 were fully up to date for the Advisory Committee on Immunization Practices-recommended vaccinations, excluding rotavirus vaccination, at the time of discharge or transfer. After developing and implementing an action plan, however, the on-time immunization rate jumped to 94% in the 155 patients discharged during the first 6 months of the new program.

“We were able to find that within our unit a small number of quality improvement measures enabled us to drastically increase our vaccination rate in this population. I think this shows that other units ought to be auditing their immunization rates, and if they find similar root causes of low rates our experience could be generalized to those units as well,” Dr. Stetson said.

It’s well established that premature infants are at increased risk for underimmunization. Dr. Stetson and his coinvestigators deemed the baseline 56% on-time immunization rate in their NICU patients to be unacceptable, because underimmunized infants are more vulnerable to vaccine-preventable illnesses after discharge. So using the quality improvement methodology known as DMAIC – for Define, Measure, Analyze, Improve, Control – the investigators surveyed Mayo NICU physicians and nurses and identified three root causes of the quality gap: lack of staff knowledge of the routine immunization schedule, lack of awareness of when a NICU patient’s vaccines were actually due, and parental vaccine hesitancy.

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Dr. Stetson and his coworkers then introduced three quality improvement measures: They provided easy Intranet access to the Advisory Committee on Immunization Practices (ACIP) routine immunization schedule, plus an Excel-based checklist that automatically red flagged when a baby was due for an immunization that hadn’t been given, and guidance on how to address parental vaccine hesitancy. Thereafter, the on-time immunization rate began its sharp upward climb.

Session chair Karina Butler, MD, was clearly impressed.

“You make it sound so easy to get such an increment. What were the barriers and obstacles you ran into?” asked Dr. Butler of Temple Street Children’s University Hospital, Dublin.