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Quality Improvement Project to Reduce Delayed Vaccinations in Preterm Infants

Cuna, Alain MD; Winter, Lindy MD

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000398
Clinical Issues in Neonatal Care

Background: Preterm infants are especially vulnerable to infectious diseases. Although vaccinations are a safe and effective measure to protect preterm infants from vaccine-preventable diseases, delays in vaccinations are not uncommon.

Purpose: The goal of this quality improvement project was to improve on time vaccinations of preterm infants hospitalized in the neonatal intensive care unit.

Methods: The Plan-Do-Study-Act model of quality improvement was adopted to develop, test, and implement interventions aimed at improving timely vaccination of preterm infants. The primary outcome measure of interest was the rate of on time vaccination, which was defined as the proportion of medically eligible preterm infants who received vaccinations within 2 weeks of the recommended schedule.

Results: Baseline on time vaccination rate was only 36%. Following several Plan-Do-Study-Act cycles, a steady increase in on time vaccinations of eligible infants was observed, and a new baseline on time vaccination rate of 82% was achieved.

Implications for Practice: Simple interventions implemented within the context of Plan-Do-Study-Act cycles are effective in improving timely vaccinations among preterm infants.

Implications for Research: Future research that focuses on vaccinations in preterm infants is needed to further reinforce the safety and efficacy of vaccines. Effective methods on how to disseminate and apply this knowledge to practice should also be studied.

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Department of Pediatrics, Children's Mercy Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO (Dr Cuna); and Department of Pediatrics, Children's of Alabama and University of Alabama at Birmingham, Birmingham, AL (Dr Winter).

Correspondence: Alain Cuna, MD, Division of Neonatology, Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108 (

This study was conducted in The University of Alabama at Birmingham.

There is no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2017 by The National Association of Neonatal Nurses