title: Association of a Best-Practice Alert and Prenatal Administration With Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccination Rates.
abstract: OBJECTIVE
  To evaluate how implementation of a best-practice alert, a reminder of clinical guidelines within the electronic medical record, in combination with the recommended change in immunization timing from postpartum to antepartum, affected tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) rates, and to examine the association of vaccination with local pertussis attack rates.
  
  
  METHODS
  A Tdap best-practice alert was introduced into the electronic prenatal charting system in June 2013. The best-practice alert was designed to appear starting at 32 weeks of gestation and to reappear at every subsequent encounter until vaccine acceptance was recorded or delivery occurred. The overall acceptance rate was then compared with postpartum vaccination rates at our institution from the previous year. Records of pertussis cases in children younger than 2 years of age diagnosed since 2012 in Dallas County were also reviewed to correlate local trends with vaccination efforts.
  
  
  RESULTS
  Of the 10,201 women offered Tdap during prenatal care, 9,879 (96.8%) ultimately accepted. This is compared with a 48% (5,064 of 10,600) Tdap postpartum immunization rate in the year prior, before introduction of the best-practice alert. The incidence of pertussis among neonates born to mothers who received prenatal care at Parkland Hospital showed a nonsignificant decline from 13 cases per 10,000 deliveries (19 of 14,834, 95% confidence interval [CI] 7-19) between January 2012 and May 2013 to seven per 10,000 deliveries during the study period (eight of 11,788, 95% CI 2-11, P=.174).
  
  
  CONCLUSIONS
  The use of a best-practice alert, in concert with the recommended change in timing of maternal vaccination from postpartum to antepartum, was associated with an increase in the Tdap immunization rate to 97%.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Health and Hospital System, Dallas, Texas; and Dallas County Department of Health and Human Services, Dallas, Texas.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Morgan
authors.forename: Sangameshwar R
authors.initials: SR
authors.lastname: Baggari
authors.forename: Wendy
authors.initials: W
authors.lastname: Chung
authors.forename: Julia
authors.initials: J
authors.lastname: Ritch
authors.forename: Donald D
authors.initials: DD
authors.lastname: McIntire
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Sheffield
mesh_terms: D000328:Adult; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007114:Immunization / Q000379:methods / Q000592:standards; D015994:Incidence; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D017010:Reminder Systems; D013781:Texas; D017748:Time Management; D014917:Whooping Cough / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines