P2C030: Optimizing the EMR Using Best Practice Advisory Alerts to Reduce Time to Immunization Administration in the NICU

Purpose/Objectives: The literature suggests that infants discharged from NICU experience delays in receiving routine immunizations, whether it be due to their low birthweight, prematurity, or critical condition placing already at-risk patients at greater risk of contracting preventable diseases. Improving the timeliness of vaccination is key to reducing the number of patients who are unvaccinated or behind due to a prolonged catch-up schedule. A QI initiative was designed to assess the adherence of a best practice alert (BPA) notifying prescribers of patients needing immunizations. The BPA was implemented in the electronic medical record (EMR) in a Level IV NICU with a goal to decrease the days to immunization administration by 20% after one year.

Design/Methods: A BPA was developed by a multidisciplinary team to alert prescribers upon chart entry of the need for immunizations based on the date of birth and immunization schedule for every neonate admitted to the NICU. An immunization panel grouped by age was built to accompany the alert and direct the prescriber to the necessary immunizations using the Centers for Disease Control and Prevention (CDC) recommended schedule. The BPA and panel were approved by the neonatology division at UTMB Health in June 2021 and placed in production within the EMR in July 2021. A six-month pre-implementation retrospective chart review was performed to obtain baseline time to immunization. A post-implementation chart review to assess time to administration was performed for July 2021-December2022. BPA firing data was also evaluated for this period. Descriptive statistics and student’s t-test were performed to evaluate data.

Results: Patients were evaluated between January 2021 and June 2021 (n=22) to establish a baseline time to immunization. All patients in which the BPA fired between July 2021 and December 2022 (n=79) were evaluated in the post-intervention group. The mean length of time between patients qualifying for 2-month immunizations to the time of administration was reduced from 18.7 + 28.6 days to 0.49 + 1.52 days (p = 0.007). Furthermore, the mean length of time between patients qualifying for 4- and 6-month immunizations to the time of administration was reduced from 25.6 + 56 days to 0 days (p = 0.077), and 14.2 + 16.9 days to 0 days (p = 0.056), respectively.

Conclusion/Discussion: Use of the BPA linked with order panels to notify prescribers of patients due to receive immunizations aided in the timely prescribing of vaccines and result in 97.4% reduction in time to administration. There was a statistically significant reduction in the time to immunization for 2-month immunizations. Timely administration of immunizations while in the NICU aids in protection against preventable diseases in these high-risk patients, as well as improves transitions of care by ensuring patients are up to date on vaccines prior to discharge.