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Jones AL, Campbell MJ, Abernathy B, Neubert S, Hager A, Collier H, Ramsey EZ, Simon A, Schachtner S, Natarajan S. Improvement in Palivizumab Administration Prior to Discharge for Hospitalized Infants with Hemodynamically Significant Congenital Heart Disease: A Quality Improvement Initiative. Pediatr Cardiol 2023:10.1007/s00246-023-03163-4. [PMID: 37145121 PMCID: PMC10625646 DOI: 10.1007/s00246-023-03163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Abstract
In this quality improvement initiative, we aimed to increase provider adherence with palivizumab administration guidelines for hospitalized infants with hemodynamically significant congenital heart disease. We included 470 infants over four respiratory syncytial virus (RSV) seasons from 11/2017 to 03/2021 (baseline season: 11/2017-03/2018). Interventions included the following: education, including palivizumab in the sign-out template, identifying a pharmacy expert, and a text alert (seasons 1 and 2: 11/2018-03/2020) that was replaced by an electronic health record (EHR) best practice alert (BPA) in season 3 (11/2020-03/2021). The text alert and BPA prompted providers to add "Need for RSV immunoprophylaxis" to the EHR problem list. The outcome metric was the percentage of eligible patients administered palivizumab prior to discharge. The process metric was the percentage of eligible patients with "Need for RSV immunoprophylaxis" on the EHR problem list. The balancing metric was the percentage of palivizumab doses administered to ineligible patients. A statistical process control P-chart was used to analyze the outcome metric. The mean percentage of eligible patients who received palivizumab prior to hospital discharge increased significantly from 70.1% (82/117) to 90.0% (86/96) in season 1 and to 97.9% (140/143) in season 3. Palivizumab guideline adherence was as high or higher for those with "Need for RSV immunoprophylaxis" on the problem list than for those without it in most time periods. The percentage of inappropriate palivizumab doses decreased from 5.7% (n = 5) at baseline to 4.4% (n = 4) in season 1 and 0.0% (n = 0) in season 3. Through this initiative, we improved adherence with palivizumab administration guidelines for eligible infants prior to hospital discharge.
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Affiliation(s)
- Andrea L Jones
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Matthew J Campbell
- Division of Cardiology, Department of Cardiovascular Medicine, Nemours Children's Hospital, Wilmington, DE, 19803, USA
| | | | - Stephanie Neubert
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alyssa Hager
- Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Hailey Collier
- Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Evan Zachary Ramsey
- Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Anna Simon
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Susan Schachtner
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Shobha Natarajan
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Labeau SO. Recommendation and protocol compliance: "Yes, I do" may not be true; the complexity of measuring provider adherence. Intensive Crit Care Nurs 2020; 60:102890. [PMID: 32536513 PMCID: PMC7529399 DOI: 10.1016/j.iccn.2020.102890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Affiliation(s)
- S O Labeau
- HOGENT University of Applied Sciences and Arts, Faculty of Education, Health and Social Work, Nursing Dept., Keramiekstraat 80, 9000 Ghent, Belgium.
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