Background:

Infants cared for in neonatal intensive care units (NICU) are at risk for under-immunization at time of hospital discharge. Adherence to the routine immunization schedules such as the schedule recommended by the United States Advisory Committee for Immunization Practices minimizes the risk of contracting vaccine preventable illnesses in this vulnerable population. We performed an audit of infant immunization rates for the Mayo Clinic Rochester NICU to evaluate and improve this measure.

Methods:

Immunization rates were obtained via review of the electronic health records of all infants discharged from the Mayo Clinic NICU. We analyzed additional baseline data including provider and nursing surveys using Pareto Chart, 5 Whys, and Fishbone diagram. We identified the following root causes of the quality gap: lack of provider knowledge of the routine immunization schedule, providers not ordering vaccines when they were due, and parental vaccine hesitancy. In the first plan-do-study-act cycle, three improvement measures were initiated including intranet resources for NICU providers on the routine immunization schedule, education on vaccine hesitancy, and an Excel-based checklist to track when immunizations were due.

Results:

Baseline data prior to interventions from January 2015 to June 2017 demonstrated that only 56% (419 of 754) of the infants cared for in the Mayo Clinic NICU were fully up-to-date for recommended immunizations at the time of discharge or hospital unit transfer. Over the six months of the improvement phase, this rate rose to 94% (145 of 155), p-value <0.0001.

Conclusions:

Infants cared for in NICUs are at increased risk of under-immunization at the time of hospital discharge. This study demonstrates that immunization rates for this population can be improved with a small number of quality improvement measures including provider education and checklists to track infant immunization status.

IMPROVING ON-TIME IMMUNIZATION RATES IN THE MAYO CLINIC NEONATAL INTENSIVE CARE UNIT