Tdap in Pregnancy: A Quality Improvement Project [2C

Abstract

INTRODUCTION: Current recommendations are for Tdap vaccination during each pregnancy to induce immunity in the neonate. Administration rates were low at a prenatal clinic in Tampa, Florida and so a quality improvement project was undertaken to improve coverage. We sought to evaluate the effectiveness of a protocol to improve the rates of prenatal Tdap vaccine administration. METHODS: This project was implemented at a single publicly funded obstetric clinic and its affiliated academic hospital. Women receiving care at the clinic are predominately underserved minorities and working poor. The clinic's providers include physicians, nurses, midwives, and nurse practitioners. The intervention had several components: In February 2016, clinic providers received education about current recommendations regarding Tdap vaccination in pregnancy. Posters were placed throughout the clinic to motivate the patients. Finally, the hospital's administration agreed to redirect money previously used for inpatient postpartum vaccinations to instead cover the cost of vaccination for uninsured patients during prenatal visits, when the vaccine is most effective. Vaccination rates were then compared between the four months before and after implementation. RESULTS: In the four months preceding the project, a total of 273 prenatal Tdap vaccines were given at the clinic; in the four months after, 380 were given. When divided by the total number of clinic patients delivered during these time frames, rates of vaccination improved from 40% to 63% (p < 0.001), respectively. CONCLUSION: Education, awareness, and financial assistance resulted in a significant increase in the Tdap vaccination rate at the clinic. Further Plan-Do-Study-Act cycles are planned to further improve vaccination rates.