quality improvement; immunization; immunization schedule; hepatitis B; pediatrics; public health; electronic health records


Community Health and Preventive Medicine | Family Medicine | Pediatrics | Primary Care | Quality Improvement



Hepatitis B is an infectious deoxyribonucleic acid virus which can cause significant morbidity and mortality. There is no current definitive treatment, however in the United States immunization is widely available. A paper published by the Advisory Committee on Immunization Practices/Centers for Disease Control (ACIP/CDC) in 2018 made updated recommendations regarding vaccination practices in the United States. The most notable change made was that all healthy newborns weighing ≥2000 g with a negative hepatitis B-status mother should receive hepatitis B immunization within 24 hours of birth. This quality improvement project studied the effect of the electronic medical record newborn admission order set, altered to reflect current societal recommendations, and the resulting newborn hepatitis B immunization rates.


The electronic medical record admission order set was modified to reflect the most recent recommendations made by ACIP/CDC. Hepatitis B immunization rates were then analyzed prior to and following the order set changes.


The most significant effect was seen in the overall rate of hepatitis B immunization achieved prior to hospital discharge. In the 12 months before order set modifications were implemented the rate was 9.5%. Following electronic medical record changes it improved to over 90%. In addition, the immunization rate performed within the first 24 hours increased from 74.1% to 91.1%. Finally, these records were made accessible to outpatient providers via a statewide immunization database.


This project serves as an example of how modifying order sets can have a dramatic effect on ordering practices and therefore allows for quality improvement.

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