Introducing Printed Postpartum Orders For Measles-Mumps-Rubella Vaccination: A Qualitative Study

Abstract

Objective: After introducing printed postpartum orders at our centre, we observed a large increase in measles-mumps-rubella (MMR) vaccination of susceptible women. The objective of this study was to ascertain factors responsible for the success of our approach and to identify potential obstacles so as to facilitate the implementation of similar policies at other hospitals.Methods: For this qualitative study, taped semi-structured interviews were carried out with physicians, nurses, and a ward clerk regarding their views on postpartum MMR vaccination and on various aspects of implementing a printed postpartum order sheet that included MMR vaccination of susceptible women. Interviews were transcribed and the responses classified by theme. Thematic analysis was used to identify strengths and weaknesses of this approach.Results: Following implementation of printed postpartum orders that included MMR vaccination of susceptible women, the proportion of eligible women vaccinated increased from 12.1 to 81.7% (risk ratio 6.8, 95% confidence interval [CI] 3.3, 13.7). While the physician and nursing staff broadly supported this initiative, we identified the need for changes in obstetrical care and documentation: most importantly, a comprehensive protocol with supporting information and guidelines should be provided for postpartum nurses; and a system must be in place to ensure that the completed antenatal record, including screening test results, be available in the expected hospital of delivery by the late second trimester.Conclusion: Previously undocumented claims that standing orders for postpartum MMR vaccination will increase the rate of vaccination of susceptible women have now been substantiated at one centre. Nevertheless, careful infrastructure and systems changes are required to ensure implementation of such orders.