Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries.

Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal for rate of administration.In response to updated Advisory Committee on Immunisation Practices recommendations to administer the dose within 24 hours of birth, we used quality improvement methodology to implement changes that would increase the vaccination rates of healthy newborns in our nurseries. The goal was to improve the proportion of infants who receive the hepatitis B vaccine within 24 hours of birth to >90% within a 2-year period, with a secondary goal of increasing vaccination rates prior to discharge from the nursery to >95%.Multiple Plan-Do-Study-Act (PDSA) cycles were performed. Initial cycles focused on increasing nurse and provider awareness of the updated timing recommendations. Later cycles targeted nursing workflow to facilitate timely administration of the vaccine. We implemented changes at our university medical centre and community hospital newborn nurseries.At the university medical centre nursery, both primary and secondary goals were met; the rate of hepatitis B vaccine administration within 24 hours increased from 81.7% to 96.2%, with vaccine administration prior to discharge increasing from 93.4% to 97.9%. In the community hospital nursery, the baseline rate of hepatitis B vaccine administration within 24 hours was 78.1%, and this increased to 85.8% with the interventions, falling short of the target of >90%. Vaccine administration prior to discharge increased from 87.2% to 92.0%, also not meeting the secondary target of 95%.Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery.

An exploratory comparison of medication lists at hospital admission with administrative database records.

BACKGROUND: Medication reconciliation is recognized as important, but no one method has been recommended. Research has shown that the most common medication reconciliation errors are attributable to omitted medications and doses. The pharmacy claims aggregator used in this evaluation is a private company that gathers pharmacy claims data from disparate pharmacy benefit managers into a secure repository (hereafter referred to as the claims database) under contracts with public and private health plans. A web interface for the repository can be used by subscribing health systems and health care providers to view patient-level pharmacy claims data to support patient care. At the time of this study, the claims database contained information from 5 public and private health insurance programs covering approximately 500,000 enrollees in Arizona. OBJECTIVE: To compare current medication lists (medication name and strength) collected by patient interview upon admission at a medical center with those collected by a company that aggregates pharmacy claims data. METHODS: This study was a retrospective chart review. A list of 300 patients was produced by a medical center using random number generation for patients who were (a) admitted to the medical center from January 1, 2007, through June 30, 2007; (b) aged 18 years or older; and (c) enrollees of health plans that send pharmacy claims data to the claims database. The first 100 patients on this list who were found in the claims database were included in the study sample. Patient-reported current medication information recorded on the medical center's admission medication reconciliation form was compared with the current medication information in the claims database at the time of admission. Medications, including prescription drugs, over-the-counter (OTC) products, supplements, and herbals, were considered current in the medication reconciliation form based on patient reports of medications still being taken upon admission to the medical center. Medications were considered current in the claims database if the most recent fill date plus days supply was equal to or greater than the hospital admission date. Data were collected by an investigator on a standardized data collection form designed for this evaluation. The investigator gathered information from the medical center for each study patient and then queried each patient in the claims database to record data. These 2 medication lists were matched, and discrepancies were noted both at the patient-drug level and at the patient level. Rates of omissions and discrepancies were calculated for each information source, and the McNemar chi-square test for binomial proportions in matched-pair data was used to assess the statistical significance of differences between information sources. RESULTS: Of the 100 patients, a total of 78 patients had medication reconciliation records in their medical center charts that could be compared with claims data. A total of 280 medications were listed for these 78 patients, with 196 medications recorded in the claims database and 131 recorded on the medication reconciliation form. At the patient-drug level, significantly more medications and strengths were listed in the claims database than in the medication reconciliation form (medications: 70.0% of 280 vs. 46.8% of 280, respectively; strengths: 100.0% of 196 vs. 71.8% of 131, respectively; both comparisons P < 0.001). One-half of the medications omitted in the claims database (42 of 84) were OTC medications. On a patient level, there was no significant between-source difference in the proportion of patients who had at least 1 missing medication (44.9% claims vs. 52.6% medication reconciliation form, P = 0.337), but there was a significant difference in the proportion of patients for whom at least 1 strength was missing (0.0% claims vs. 23.1% medication reconciliation form, P < 0.001). All medications and strengths matched in 24 of 78 (30.8%) patients. CONCLUSION: Information collected using a claims database produced a more complete list of medication names and strengths than that compiled upon admission interviews at the medical center. However, the claims database did not contain information about medications that were not reimbursed by insurance. The most accurate method of obtaining the complete medication list may be to combine these 2 techniques.