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Improvement in Palivizumab Administration Prior to Discharge for Hospitalized Infants with Hemodynamically Significant Congenital Heart Disease: A Quality Improvement Initiative

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Abstract

In this quality improvement initiative, we aimed to increase provider adherence with palivizumab administration guidelines for hospitalized infants with hemodynamically significant congenital heart disease. We included 470 infants over four respiratory syncytial virus (RSV) seasons from 11/2017 to 03/2021 (baseline season: 11/2017–03/2018). Interventions included the following: education, including palivizumab in the sign-out template, identifying a pharmacy expert, and a text alert (seasons 1 and 2: 11/2018–03/2020) that was replaced by an electronic health record (EHR) best practice alert (BPA) in season 3 (11/2020–03/2021). The text alert and BPA prompted providers to add “Need for RSV immunoprophylaxis” to the EHR problem list. The outcome metric was the percentage of eligible patients administered palivizumab prior to discharge. The process metric was the percentage of eligible patients with “Need for RSV immunoprophylaxis” on the EHR problem list. The balancing metric was the percentage of palivizumab doses administered to ineligible patients. A statistical process control P-chart was used to analyze the outcome metric. The mean percentage of eligible patients who received palivizumab prior to hospital discharge increased significantly from 70.1% (82/117) to 90.0% (86/96) in season 1 and to 97.9% (140/143) in season 3. Palivizumab guideline adherence was as high or higher for those with “Need for RSV immunoprophylaxis” on the problem list than for those without it in most time periods. The percentage of inappropriate palivizumab doses decreased from 5.7% (n = 5) at baseline to 4.4% (n = 4) in season 1 and 0.0% (n = 0) in season 3. Through this initiative, we improved adherence with palivizumab administration guidelines for eligible infants prior to hospital discharge.

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Abbreviations

AAP:

American Academy of Pediatrics

BPA:

Best Practice Alert

CCU:

Cardiac Care Unit

CHOP:

Children’s Hospital of Philadelphia

EHR:

Electronic health record

QI:

Quality improvement

RSV:

Respiratory syncytial virus

SPC:

Statistical process control

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Acknowledgements

Kristin McNaughton, MHS, for editing assistance, Children’s Hospital of Philadelphia. No conflicts of interest to report. Kyle Winser for statistical assistance, Children’s Hospital of Philadelphia. No conflicts of interest to report.

Funding

Dr. Andrea L. Jones was supported by T32-HL007915.

Author information

Author notes

  1. Andrea L. Jones and Matthew J. Campbell have contributed equally.

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania Perelmen School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Andrea L. Jones, Stephanie Neubert, Anna Simon, Susan Schachtner & Shobha Natarajan

  2. Division of Cardiology, Department of Cardiovascular Medicine, Nemours Children’s Hospital, Wilmington, DE, 19803, USA

    Matthew J. Campbell

  3. Heart Center, St. Louis Children’s Hospital, St. Louis, MO, 63110, USA

    Brittany Abernathy

  4. Department of Pharmacy Services, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Alyssa Hager, Hailey Collier & Evan Zachary Ramsey

Authors
  1. Andrea L. Jones
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  2. Matthew J. Campbell
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  3. Brittany Abernathy
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  4. Stephanie Neubert
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  5. Alyssa Hager
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  7. Evan Zachary Ramsey
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  8. Anna Simon
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  9. Susan Schachtner
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  10. Shobha Natarajan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ALJ and MJC. The first draft of the manuscript was written by ALJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Andrea L. Jones.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This Quality Improvement Initiative was reviewed and determined to not meet the criteria for human subjects’ research by the CHOP Institutional Review Board.

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (TIF 177 KB)

Example text message alert to fellow physician regarding possible palivizumab eligibility.

Supplementary file2 (DOCX 14 KB)

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Jones, A.L., Campbell, M.J., Abernathy, B. et al. Improvement in Palivizumab Administration Prior to Discharge for Hospitalized Infants with Hemodynamically Significant Congenital Heart Disease: A Quality Improvement Initiative. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03163-4

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  • DOI: https://doi.org/10.1007/s00246-023-03163-4

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