Pedersen Daniel, Rodriguez Angelina, Oyesanmi Olu, Schramm Heather, King Michael
Oak Hill Hospital, Brooksville, FL.
University of South Florida Morsani College of Medicine/HCA Healthcare GME Consortium.
HCA Healthc J Med. 2020 Dec 29;1(6):507-512. doi: 10.36518/2689-0216.1152. eCollection 2020.
Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission order set, altered to reflect current societal recommendations, and the resulting newborn hepatitis B immunization rates.
The electronic medical record admission order set was modified to reflect the most recent recommendations made by ACIP/CDC. Hepatitis B immunization rates were then analyzed prior to and following the order set changes.
The most significant effect was seen in the overall rate of hepatitis B immunization achieved prior to hospital discharge. In the 12 months before order set modifications were implemented the rate was 9.5%. Following electronic medical record changes it improved to over 90%. In addition, the immunization rate performed within the first 24 hours increased from 74.1% to 91.1%. Finally, these records were made accessible to outpatient providers via a statewide immunization database.
This project serves as an example of how modifying order sets can have a dramatic effect on ordering practices and therefore allows for quality improvement.
乙型肝炎是一种传染性脱氧核糖核酸病毒，可导致严重的发病和死亡。目前尚无确切的治疗方法，然而在美国，免疫接种广泛可用。免疫实践咨询委员会/疾病控制中心（ACIP/CDC）于2018年发表的一篇论文对美国的疫苗接种实践提出了更新建议。最显著的变化是，所有体重≥2000克、母亲乙肝状态为阴性的健康新生儿应在出生后24小时内接种乙肝疫苗。本质量改进项目研究了电子病历新生儿入院医嘱集（根据当前社会建议进行了修改）的效果以及由此产生的新生儿乙肝疫苗接种率。
修改电子病历入院医嘱集以反映ACIP/CDC提出的最新建议。然后分析医嘱集更改前后的乙肝疫苗接种率。
在出院前实现的乙肝疫苗接种总体率方面观察到了最显著的效果。在实施医嘱集修改前的12个月里，接种率为9.5%。电子病历更改后，接种率提高到了90%以上。此外，在出生后24小时内进行的接种率从74.1%提高到了91.1%。最后，这些记录通过全州范围的免疫数据库可供门诊提供者访问。
该项目展示了修改医嘱集如何能对医嘱开具实践产生巨大影响，从而实现质量改进。
