Sustained Improvement in Administration of the Hepatitis B Vaccine Birth Dose: A Quality Improvement Initiative

The New York State Department of Health recommends the administration of the hepatitis B vaccine birth dose within 12 hours of life (HOL) for all full-term babies irrespective of maternal hepatitis B status. The primary and secondary aims of the project were to improve the timeliness of vaccine administration and increase the total number of infants vaccinated prior to discharge. Multiple Plan-Do-Study-Act cycles were performed. Statistical process charts of percentages of vaccination within 12 HOL and prior to discharge were constructed with 3-σ (data within 3 standard deviations from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Administration within 12 HOL improved from 13% to ≥65% within 6 months, and has been sustained for >1 year. Vaccine administration prior to discharge increased from 94% to 98%. Quality improvement methods can rapidly improve adherence to newborn vaccine recommendations and these effects are sustainable.