Original Article

Enhancing Hepatitis A and B Vaccinations Through Electronic Clinical Decision Support Systems and Staff Education in a Correctional Facility

Atem, Jude N. DNP, MS, MSN, APRN¹; El Ghaziri, Mazen PhD, MPH, RN¹

Author Affiliation:¹Solomont School of Nursing, University of Massachusetts Lowell.

The authors declare no conflict of interest.

Correspondence: Jude N. Atem, 19 Columbus Ave., Methuen, MA 01844. E-mail: [email protected].

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 (www.journalforensicnursing.com).

Received May 1, 2022; accepted for publication February 10, 2023.

Journal of Forensic Nursing ():10.1097/JFN.0000000000000437, March 30, 2023. | DOI: 10.1097/JFN.0000000000000437

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Abstract

Background: Despite the prevalence and risks for hepatitis A virus (HAV) and hepatitis B virus (HBV) infection and the availability of safe and effective vaccines, HAV/HBV vaccinations are disproportionately low in jails. This quality improvement project evaluated the effectiveness of clinical decision support systems: electronic standing orders to nurses, clinical alerts to nurses and healthcare providers, and secondarily staff education in enhancing HAV and HBV vaccination and knowledge of hepatitis infection. Methods: We distributed a validated self-report hepatitis knowledge questionnaire (α = 0.7–0.8) before and after an educational presentation to nurses, nurse practitioners, and physicians (N = 26) at a Northeastern state jail and then embedded electronic clinical alerts and standing orders in the electronic medical record. The questionnaire assessed pre- and posteducation knowledge scores. The number of vaccine status screenings and vaccinations was retrieved from the electronic medical record 3 months pre- and post-implementation. Descriptive statistics and the Wilcoxon signed-ranks test were used for data analysis. Results: Twenty-one participants completed the pretest, 18 attended the educational intervention, and 15 completed the posttest. Vaccine status screening increased by 97.5%, and HAV and HBV vaccinations increased by 8.7%. Knowledge scores improved significantly post-intervention (p = 0.04), with an effect size of r = 0.67). Discussion/Conclusion: Using the Donabedian quality of care model, we showed that quality initiatives are feasible in a jail setting. Implementing a clinical decision support system and education improved the vaccination rate, which may decrease HAV/HBV incidence in the jail and prevent community spread.