Recent revision (2/2013) of vaccination guidelines by the CDC recommends all pregnant women receive Tdap vaccination during the third trimester of each pregnancy and that prenatal providers implement an immunization program for all pregnant women. This quality improvement study examines a cohort of pregnant patients from November 2013 and evaluates vaccination rates.METHODS:
We conducted a retrospective cohort study of women receiving prenatal care at OUWC Tulsa during November 2013. Primary outcomes included percentage of pregnant women who received Tdap vaccination during their pregnancy and documented counseling rates. Secondarily we examined the relationship of vaccination rates to gestational age and provider clinic.RESULTS:
Of 334 women, 16% received Tdap vaccination and 21% of the charts documented patient counseling. Of those that didn't receive the vaccine, 95% had no documented reason. Of the patients that were counseled, 76% accepted the vaccine. Of the patients who were counseled but not vaccinated, 3% declined and 2% received it elsewhere. Data from provider clinics showed counseling and vaccination rates declined with increasing patient complexity. Vaccinations administered during the optimal gestational age totaled 83%.CONCLUSION:
The results of our study indicate a need for improvement in Tdap vaccination protocol at OUWC. Follow up preliminary data showed∼35% of patients received Tdap in a cohort from 8/2014. After implementing a protocol with directed education for providers and staff, preliminary 6/2015 data revealed∼50% of patients received Tdap vaccination. A time series quality improvement project currently in process includes patient educational handouts, further provider training, and a standardized documentation system.