University of Northern Colorado
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University of Northern Colorado
Pertussis is a highly contagious, acute respiratory illness caused by the bacteria Bordetella pertussis. This illness can last for several months and is most notable by a paroxysmal cough on inspiration. Pertussis affects all ages and genders without discrimination but has a disproportionately high rate of morbidity and mortality in infants less than three months old. Protection from pertussis comes in the form of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine for adults and the diphtheria, tetanus, acellular pertussis (DTaP) vaccine for children and infants. The first whole cell pertussis vaccine was introduced in the 1940s, which brought about a dramatic decrease in pertussis rates. This vaccine was associated with high fevers and seizures in children. This version of the vaccine was removed from the market in the 1980s and a safer acellular alternative was introduced. The acellular vaccine had fewer side effects; however, immunity was noted to wane and pertussis incidence began to increase. Infants who did not receive their first dose of Tdap until two months of age were left vulnerable after exposure to adolescents and adults with pertussis. In October 2012, the Centers for Disease Control (CDC; 2013b), in conjunction with the American Council for Immunization Practices (ACIP), released a national recommendation to provide every pregnant woman with a Tdap vaccine between 27- and 36-weeks gestation. Vaccination during pregnancy would induce an immune response, creating antibodies passed on to the fetus. The purpose of this project was to improve the rates of Tdap in the pregnant population at North Colorado Family Medicine (NCFM) in Greeley, Colorado. The project included three specific interventions: (a) update of an existing provider reminder tool located in every obstetric patients chart to include a prompt to give the Tdap vaccine between 27 and 36 weeks, (b) inclusion of a patient-oriented CDC (2015c) factsheet in the new patient packet given to every pregnant patient at the initial intake visit, and (c) an educational session provided to the clinic’s medical assistants to offer education on the purpose of the Tdap during pregnancy and their role in administering the vaccine under the clinic’s standing order. This project was implemented over a 14-week intervention period and results were measured with comparison of pre- and post-intervention vaccine rates and provider/medical assistant surveys. Pre-intervention rates were calculated after chart review of all pregnancy and delivery codes for 2013-2015 after the initial recommendation. Prior to the intervention, a total of 394 women delivered and 274 of those women were given the vaccine (69%). Post-intervention chart reviews showed a total of 74 pregnant women were seen in the intervention window and 65 of those women were given the vaccine (88%). Post-intervention provider and medical assistant surveys were distributed with a return rate of 48% for providers and 75% for medical assistants. Survey results showed participating medical assistants and providers agreed or strongly agreed the interventions would be beneficial in reminding them to provide the Tdap vaccine to pregnant women between 27- and 36-weeks gestation. Indirectly, an increase in Tdap vaccination rates in pregnant women would likely decrease pertussis rates and, therefore, the morbidity and mortality in infants less than three months of age. This project was sustainable with future implications in practice as it utilized up-to-date evidence in an effort to increase rates of adherence to national recommendations and reduce rates of pertussis in a vulnerable population. As the clinic is part of a larger system, the interventions can be disseminated to the different Banner health clinics and have a wider impact on pregnant women throughout the western United States.
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