Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy.
Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy.
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DOI：
10.1542/hpeds.2021-005969
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发表时间：
2021-12-01
影响因子：
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通讯作者：
Mukhopadhyay, Sagori
中科院分区：
文献类型：
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作者：
Pulsifer, Allene;Puopolo, Karen M;Skerritt, Lauren;Dhudasia, Miren B;Pyle, Beth Ann;Schumacher, Aida;Mukhopadhyay, Sagori
2017年9月，美国儿科学会发布指南，建议出生体重≥2000克的健康新生儿在出生后24小时内接种B型肝炎疫苗。当时，约85%的健康新生儿在出院前在我们中心接种了疫苗，然而，只有35%的新生儿在出生后24小时内接种了疫苗。我们的目标是到2018年6月，在保持总体疫苗接种率的同时，在出生后24小时内为70%符合条件的新生儿接种疫苗。一个多学科的改进小组分析了现有的疫苗管理过程中，以及新生儿托儿所。从2017年10月到2018年1月，对疫苗订单的激活以及获得和记录同意过程进行了更改。疫苗接种与出生后≤24小时的常规护理捆绑在一起，父母脚本从提供疫苗作为一种选择改为将其作为一种建议。从2016年11月至2019年6月，我们使用统计过程控制方法确定了疫苗接种的总体比率和时间。在10，887名合格婴儿中，在工艺控制图上出现特殊原因变异的工艺变更后，出生后≤24小时接种B肝炎疫苗的比例从35.5%增加到78.8%。出院前任何时间接种疫苗的婴儿比例也从86.5%增加到92.3%。具体的流程变更使我们的出生中心能够遵守合格新生儿出生后≤24小时内接种B型肝炎疫苗的建议时间。
In September 2017, the American Academy of Pediatrics issued guidance recommending hepatitis B vaccine be administered to well newborns with birth weight ≥2000 grams within 24 hours after birth. At that time ~85% of well newborns were vaccinated prior to discharge at our center, however, only 35% were vaccinated within 24 hours after birth. Our aim was to vaccinate 70% of eligible newborns within 24 hours after birth by June 2018, while maintaining the overall rate of vaccination. A multidisciplinary improvement team analyzed existing vaccine administration processes in the well newborn nursery. From October 2017 to January 2018, changes were made to activation of vaccine orders, and to obtaining and documenting the consent processes. Vaccine administration was bundled with routine care given ≤24 hours after birth, and parent scripting was changed from offering vaccine as an option to stating it as a recommendation. From 11/2016 – 06/2019, we determined the overall rate and timing of vaccination using statistical process control methods. Among 10,887 eligible infants, the proportion administered hepatitis B vaccine ≤24 hours after birth increased from 35.5% to 78.8% after process changes with special cause variation on process control charts. Proportion of infants receiving vaccine any time prior to discharge also increased from 86.5% to 92.3%. Specific process changes allowed our birth center to comply with the recommended timing for hepatitis B vaccination of ≤24 hours after birth among eligible newborns.