116 - Improving Vaccination Rates in a Level IV NICU

Publication Number: 4114.116

Anola Stage, Children's National Health System, Washington, DC, United States; Caroline Wambach, Children's National Health System, Washington, DC, United States; Leigh M.. Finnegan, Children's National Health System, Washington, DC, United States; Nneka Nzegwu, George Washington University School of Medicine and Health Sciences, Washington, DC, United States

Background: Infants in the NICU are at high risk of developing serious complications from vaccine-preventable diseases. However, these infants often have high rates of under-immunization during their NICU stay. Prior studies show that under-immunization can persist for years, leading to continued risk of severe complications from vaccine-preventable diseases.

Objective: We evaluated the baseline vaccination rates in the Children's National Hospital level IV NICU. The aim of our quality improvement project is to increase 2-month vaccination rates within one week of eligibility by 15% over a 6-month period. We utilized the IHI Model for Improvement to implement change.

Design/Methods: Six months of baseline vaccination data were collected via chart review for patients admitted to the NICU within the first 14 days of life and still admitted at 60 days of life. Monthly vaccination rates were determined by the percentage of infants who turned 60 days old and received 2-month immunizations by day of life 67. A key driver diagram was developed, and interventions were determined using input from various team members (Fig. 1). We used the IHI Model for Improvement and Plan-Do-Study-Act (PDSA) cycles. PDSA cycle #1 involved adoption of a weekly health maintenance day to promote regular interval check-ins on infant vaccination status, and target areas of vaccine education to staff with informative flyers (Fig. 2,3). The second PDSA cycle involved designation of a health maintenance champion to issue weekly reminders to teams.

Results: Baseline rate of on-time 2-month vaccination was 50%. Review at the end of the first cycle demonstrated the need for additional unit awareness of ongoing change as well as a sustainable champion to continue practice and remind teams. These changes served as the focus of PDSA cycle #2. Over the course of 6-months, we saw the vaccination rate increase to 67% (Fig. 3).

Conclusion(s): We achieved our goal of increasing on-time 2-month vaccination by at least 65% by July 2025, using a focus on education, people, and processes to promote sustained change. Adoption of a pre-existing method of reminders utilized on the unit through the health maintenance day, as well as identifying a health maintenance champion, significantly assisted in achieving these measures. For PDSA cycle #3 we are implementing daily unit-wide discussion topics for clinical rounds, which we hope will further solidify the practice of weekly vaccine discussion. Further data collection is needed to determine if we meet our goal of sustained improvement.

Key Driver Diagram
Fig. 1: Key driver diagram demonstrating barriers to on-time vaccination that we aimed to address with our PDSA cycles.

Health Maintenance Flyer
Fig. 2: Flyer placed in fellow, resident, and advanced practice provider workrooms reinforcing the implementation of "Health Maintenance Wednesday" to promote regular discussion of vaccination status.

Vaccination Rate Run Chart
Fig. 3: Run chart demonstrating baseline vaccination rate and rates during PDSA cycles #1 and #2. The red dotted line represents the baseline unit-wide vaccination rate of 50%. The green dotted line represents the goal rate of 65% for our project.