Increasing Immunization Rates in Infants with Severe Chronic Lung Disease: A Quality Improvement Initiative
| Autor: | Karen Warren, Jean M. Carroll, Jacquelyn R. Evans, Kristin McKenna, Huayan Zhang, Kathleen Nilan, Beatriz Milet, John Chuo |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Lung Diseases
Male Pediatrics medicine.medical_specialty Population Infant Premature Diseases Dexamethasone Sepsis 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Fraction of inspired oxygen medicine Adrenal insufficiency Humans 030212 general & internal medicine education Glucocorticoids Contraindication education.field_of_study business.industry Vaccination Infant Newborn Infant General Medicine medicine.disease Quality Improvement Immunization Bronchiolitis Chronic Disease Practice Guidelines as Topic Pediatrics Perinatology and Child Health Female Health Services Research Complication business Infant Premature |
| Zdroj: | Hospital Pediatrics. 8:693-698 |
| ISSN: | 2154-1671 2154-1663 |
| DOI: | 10.1542/hpeds.2018-0046 |
| Popis: | OBJECTIVES: Immunizations provide important protection from serious childhood illnesses. Infant chronic lung disease (CLD) is a serious complication of prematurity and predisposes premature infants to respiratory morbidity, rehospitalization, and mortality. This high-risk group is especially vulnerable to infections, such as invasive pneumococcal disease, influenza, and bronchiolitis. Our purpose for this project was to increase 2-, 4-, and 6-month immunization rates in eligible infants with CLD in the NICU by 30% through December 2016. METHODS: A multidisciplinary team developed weekly targeted rounds to identify eligible patients with outstanding immunizations. Exclusion criteria included the following: (1) a fraction of inspired oxygen requirement of >80%, (2) pulmonary hypertensive crisis, (3) positive blood culture results or if within 48 hours of a sepsis evaluation, (4) if within 5 days of a surgical or interventional procedure, (5) receiving steroid treatment (not including a physiologic hydrocortisone dose for adrenal insufficiency), (6) a CLD team consensus of contraindication, and (7) parental refusal. RESULTS: The project managed 60 patients from March 2016 to December 2016. Immunization of eligible patients increased from 44% to 75% and was sustained for the next 6 months. The average number of days from admission to immunization record review decreased from 71 days at baseline to 27 days. CONCLUSIONS: The implementation of (1) an in-hospital immunization record review, (2) an e-mail reminder, (3) a weekly multidisciplinary eligibility discussion, and (4) an updated rounding tool was successful in increasing and sustaining immunization rates in this population of infants with CLD. The multidisciplinary CLD meeting was a novel opportunity to discuss immunization eligibility and safety monitoring. |
| Databáze: | OpenAIRE |
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