The Fast Track from a New Practice Recommendation to Nurse Sensitive Indicator

Abstract

Poster Presentation Purpose for the Program In response to the recent surge in pertussis across the United States, specific recommendations for pregnant women have been made by the Advisory Committee for Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) along with the American College of Obstetricians and Gynecologists (ACOG). Infants younger than age 6 months, who are too young to be vaccinated against pertussis, are the most vulnerable population with the highest mortality from this disease. The recommendations from ACIP and ACOG focus on protecting the newborn directly by targeting vaccination of the pregnant mother (to maximize maternal antibody response and passive immunity transfer to the newborn) and indirectly by cocooning (ensuring up‐to‐date vaccination status of family members and care givers who will be around the newborn). Proposed Change To expedite implementing the evolving recommendations at the bedside in our labor and delivery, antepartum, and mother/infant units by utilizing different areas of focus, including maximizing the Electronic Medical Record (EMR) for patient screening and reporting, initial and ongoing staff education, increased surveillance, implementation of a nurse driven protocol, streamlining availability of the vaccine, and implementing a family and caregiver vaccination program. Implementation, Outcomes, and Evaluation We created a patient screening tool within the admission database in the EMR, developed new reports to accurately assess vaccination status of perinatal patients, provided initial and ongoing staff education and vaccination, increased routine surveillance for adherence, implemented a nurse driven protocol to facilitate administration, streamlined availability of the vaccine on the units, and implemented a family and caregiver vaccination program. During the initial 7‐month period, approximately one half of the eligible patients were vaccinated before admission. We educated, screened for eligibility, and administered the vaccine for the other half. During this period, our tetanus–diphtheria–pertussis (Tdap) vaccination rate increased from 46% to 84%. Initially, we were steadily missing vaccinating between 33% and 54% of the eligible women who came into our facility who said they wanted the vaccine. After identifying nurse barriers to vaccination and implementing a nurse‐driven vaccine protocol we were able to decrease the missed rate to 16% within the first month. Additionally, we partnered with our outpatient pharmacy to pilot a family and caregiver vaccination program. Implications for Nursing Practice Tdap vaccination is nursing sensitive. Screening all perinatal patients for eligibility and implementing a nurse driven protocol positively affects vaccination rates.