Antepartum Vaccination Rates After Initiation of Electronic Medical Record Reminders [8L]

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Tetanus, Diphtheria and acellular Pertussis (Tdap) vaccination is recommended by the CDC between 27 and 36 weeks gestation in order to maximize maternal antibody response and passive antibody transfer to the infant. This study was developed as a quality improvement project for increasing vaccination rates in our university-based clinic.


We developed a best practice advisory alert in the electronic medical record that was implemented September 8, 2016. This alert prompts providers to order the Tdap vaccine or document previous vaccination. It is triggered during clinic visits between 27 and 36 weeks gestation. A chart review was completed for all deliveries at our hospital during a 3 month period prior to implementation and 3 month period post-implementation. A χ2 test was completed to assess differences in Tdap uptake pre- and post-implementation. A Breslow-Day test was completed to identify any differences in uptake by age, parity, and time after initiation.


A total of 531 pre-implementation and 574 post-implementation charts were reviewed and included in the analysis. The rates of appropriately timed Tdap vaccinations was significantly higher post-implementation than pre-implementation (60.28% versus 39.72% P<.0001). This change was most noticeable in the first month after implementation (P=.0123).


Use of a pop-up reminder in the electronic medical record increased Tdap vaccination rates among women during their third trimester. Although with maximum vaccination rates less than 70% at the peak, more can be done to educate providers and patients about the importance of antepartum vaccination.

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