St. Elizabeth's Medical Center, Boston, Massachusetts;
Massachusetts General Hospital, Boston, Massachusetts; and.
Hosp Pediatr. 2021 May;11(5):446-453. doi: 10.1542/hpeds.2020-002766.
When given within 24 hours of birth, the hepatitis B vaccine is up to 90% effective in preventing perinatal infection. The American Academy of Pediatrics now recommends administration within 24 hours for infants with a birth weight >2 kg, but a national benchmark for compliance with this time frame has not been established. We aimed to increase the monthly average of eligible newborns receiving the vaccine on time from 40% to 80% over a 9-month period.
A series of plan-do-study-act cycles were conducted to improve timeliness of hepatitis B vaccine birth dose administration among newborns in the level 1 nursery at our academic community hospital. Interventions included staff education, nurse-driven consent and vaccine ordering, and earlier initial newborn assessments performed by nursing staff. Our primary outcome was the monthly percentage of newborns receiving the vaccine within 24 hours of birth, and our secondary outcome was the frequency of nonvaccination events. Statistical process control was used to analyze the effectiveness of interventions.
Our mean monthly rate of vaccine administration within the 24-hour time frame increased from 40% to 92%. Predischarge vaccination rate improved from a mean of 13 to 61 cases between infants discharged without vaccination.
Nurse-led interventions, including the ability to obtain consent and incorporation of the vaccine into our nurse-activated admission order set, were significant contributors to improvement in the timeliness of hepatitis B vaccine administration. We propose a mean of 90% compliance with the American Academy of Pediatrics recommendations as a benchmark for other institutions.
乙肝疫苗在婴儿出生后 24 小时内接种，预防围产期感染的有效率高达 90%。美国儿科学会现在建议对出生体重>2kg 的婴儿在 24 小时内接种疫苗，但尚未建立遵守这一时间框架的国家基准。我们的目标是在 9 个月内，将每月按时接受疫苗接种的合格新生儿的平均比例从 40%提高到 80%。
在我们学术社区医院的一级新生儿病房，通过一系列计划-执行-研究-行动循环，提高新生儿乙肝疫苗首针接种的及时性。干预措施包括员工教育、护士驱动的同意和疫苗订购，以及护理人员更早地对新生儿进行初始评估。我们的主要结果是在出生后 24 小时内接种疫苗的新生儿每月百分比，次要结果是疫苗接种失败的频率。统计过程控制用于分析干预措施的有效性。
我们在 24 小时内接种疫苗的平均每月比例从 40%提高到 92%。在没有接种疫苗就出院的婴儿中，出院时接种疫苗的比例从平均 13 例提高到 61 例。
护士主导的干预措施，包括获得同意的能力和将疫苗纳入我们的护士激活入院医嘱集，是提高乙肝疫苗接种及时性的重要因素。我们建议以 90%的符合美国儿科学会建议作为其他机构的基准。
