Improving Newborn Hepatitis B Vaccination Compliance with the Use of an EMR Best Practice Alert: A Quality Improvement Initiative

This quality improvement project was conducted to determine if an electronic medical record (EMR) embedded best practice alert (BPA) used by obstetrical (OB) nurses increases the administration rate of the hepatitis B (HepB) vaccine within 24 hours of birth by 10% in eligible newborns in the well-baby nursery (WBN) within four weeks. Using a pre/post design, the HepB vaccine administration status for all newborns (n=120) admitted to the WBN was extracted from the EMR four weeks post-intervention and compared to four weeks of pre-intervention data. Implementation of a BPA resulted in a 17% increase in the HepB vaccination rate within 24 hours of birth, compared to pre-intervention (45% vs. 28%, p = 0.058). The vaccine rate before discharge increased by 5% compared to pre-intervention (50% vs. 55%, p = 0.583). Vaccination activity documentation in the electronic medication administration record increased by 12% compared to pre-intervention vaccination activity documentation (88% vs. 100%, p = 0.013). The length of stay was similar among newborns whose nurses did not receive the best practice alert (M = 2.2 days) compared to newborns whose nurses did receive the best practice alert (M = 2 days), indicating increased vaccination counseling did not delay discharge (p = 0.487). An EMR BPA improved compliance with the CDC guidelines for the birth dose of the HepB vaccine. Our goal of improving newborn HepB vaccine administration within 24 hours of life exceeded with a 17% increase. Keywords: Best practice alert, birth dose hepatitis B vaccine, newborn immunization