Increasing Tdap Coverage Among Postpartum Women: A Quality Improvement Intervention.
OBJECTIVE
Infants are at greatest risk for severe disease and death from pertussis; most acquire it from household contacts. Centers for Disease Control and Prevention guidelines recommend tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) vaccination for infant caregivers, especially postpartum women who did not receive it during pregnancy. Our objective was to increase the percentage of women receiving Tdap vaccine before postpartum discharge.


METHODS
An interdisciplinary workgroup identified barriers to improvement of postpartum Tdap vaccination from which a 5-step intervention was created: (1) provide education on Tdap and pertussis; (2) offer Tdap throughout hospitalization; (3) create a Tdap standing order; (4) keep Tdap as floor stock; and (5) document administration. Pre- and postintervention data were collected from monthly chart reviews. Our main outcome measures were the proportion of postpartum women eligible for Tdap and the proportion of those eligible who received Tdap.


RESULTS
Preintervention baseline data (202 charts) described 166 postpartum women eligible to receive Tdap. Of the eligible women, 91 (55%) received the Tdap vaccine. During the 9-month postintervention period, 844 charts were reviewed (average, 93 per month; range, 82-104). Of the 632 women eligible to receive the Tdap vaccine, 462 (73% overall [range, 67%-79%]) received it. Thirty-three percent more postpartum mothers received the Tdap vaccine before discharge in the postintervention period (P< .01). The percentage of women eligible decreased from 82% to 75%.


CONCLUSIONS
This quality improvement initiative substantially increased Tdap immunization in the immediate postpartum period. Efforts to increase immunization during pregnancy for passive transfer of maternal antibodies remain preferable.
General Pediatrics, Cohen Children's Medical Center of, New York, New Hyde Park, New York; hbernstein@northwell.edu.|Hofstra Northwell School of Medicine, Hempstead, New York; and.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Henry H
HH
Bernstein
Hofstra Northwell School of Medicine, Hempstead, New York; and.
Mikhaela
M
Monty
General Pediatrics, Cohen Children's Medical Center of, New York, New Hyde Park, New York.
Patriot
P
Yang
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Amy
A
Cohen
D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D050316:Medical Order Entry Systems; D009518:New York; D009732:Nursing Care; D010353:Patient Education as Topic; D049590:Postpartum Period; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D014611:Vaccination / Q000451:nursing / Q000706:statistics & numerical data*
D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines