Divisions of Neonatal Medicine and
Divisions of Neonatal Medicine and.
Pediatrics. 2019 Nov;144(5). doi: 10.1542/peds.2019-0337. Epub 2019 Oct 8.
Infants in NICUs are at risk for underimmunization. Adherence to the routine immunization schedule recommended by the Advisory Committee for Immunization Practices minimizes the risk of contracting vaccine-preventable illnesses in this vulnerable population. From January 2015 to June 2017, only 56% (419 of 754) of the infants in our Mayo Clinic level IV NICU were fully up to date for recommended immunizations at the time of discharge or hospital unit transfer. We aimed to increase this rate to 80% within 6 months.
Using the quality improvement methodology of Define, Measure, Analyze, Improve, Control, we analyzed baseline data, including provider and nursing surveys using a fishbone diagram, the 5 Whys, and a Pareto chart. We identified 3 major root causes of the quality gap: lack of provider knowledge of the routine immunization schedule, failure of providers to order vaccines when due, and hesitancy of parents toward vaccination. Using plan-do-study-act cycles, 5 improvement interventions were implemented. These included an intranet resource for NICU providers on the routine immunization schedule, an Excel-based checklist to track when immunizations were due, and provider education on parental vaccine hesitancy and vaccine safety.
During the 19-month improve and control phases of the project, the fully immunized rate at the time of NICU discharge or transfer rose from a baseline of 56% (419 of 754) to 93% (453 of 488), with a value <.001.
Our NICU significantly improved infant immunization rates with a small number of interventions. These interventions may be generalizable to other NICUs with low infant immunization rates.
新生儿重症监护病房（NICU）中的婴儿存在免疫接种不足的风险。遵循免疫实践咨询委员会推荐的常规免疫接种计划可最大程度降低该脆弱人群罹患疫苗可预防疾病的风险。从 2015 年 1 月至 2017 年 6 月，在我们梅奥诊所四级 NICU 中，仅有 56%（419/754）的婴儿在出院或转科时完全按照建议的免疫接种计划进行了接种。我们的目标是在 6 个月内将这一比例提高到 80%。
我们使用质量改进方法“定义、测量、分析、改进、控制”，分析了基线数据，包括使用鱼骨图、5 个为什么和帕累托图进行的提供者和护理人员调查。我们确定了导致质量差距的 3 个主要根本原因：提供者对常规免疫接种计划的知识缺乏、提供者未能按时接种疫苗、以及家长对接种疫苗的犹豫。通过计划-实施-研究-行动循环，实施了 5 项改进干预措施。这些措施包括为 NICU 提供者提供关于常规免疫接种计划的内部网资源、用于跟踪免疫接种时间的基于 Excel 的检查表、以及关于家长对接种疫苗的犹豫和疫苗安全性的提供者教育。
在项目的改进和控制阶段的 19 个月中，NICU 出院或转科时完全免疫接种的比例从基线时的 56%（419/754）上升至 93%（453/488），P 值<.001。
我们的 NICU 通过少量干预措施显著提高了婴儿的免疫接种率。这些干预措施可能适用于免疫接种率较低的其他 NICU。
