Article Text

  1. J. R. Roberts1,
  2. J. Martines2,
  3. S. White2,
  4. R. Battaglia2,
  5. P. M. Darden1
  1. 1Department of Pediatrics
  2. 2Department of Nursing, Medical University of South Carolina, Charleston, SC


Purpose To evaluate the effectiveness of efforts of the clinic staff to improve palivizumab compliance.

Methods In a hospital-based clinic, a number of changes in procedure for palivizumab injections were instituted for the 2004-2005 RSV season after having a poor rate of kept appointments in the prior year. Changes were as follows: (1) patients received extensive counseling about RSV at the initial visit; (2) the next appointment was made at the time of getting the injection and could be given on any day of the week; (3) a flag system was developed using the electronic medical record so that any other clinic in the MUSC system was alerted to the need that the patient would need palivizumab; (4) reminder phone calls about the appointment the day before; (5) a calendar with a sticker of first appointment and approximate times the next injection was due was given; (6) a tracking chart was placed in the nursing medication room with weight, dosage, and last injection; and (7) staff made presentations to other nursing staff meetings about the new plans, particularly the flag system. Data were examined retrospectively for the year prior to these changes (2003-2004) and for 2004-2005. Outcome measures included the proportion of patients who received the recommended number of shots and the proportion who missed an injection at least 1 month. For the whole sample, we calculated the proportion who met 100% of opportunities for injection (defined as number of shots divided by a visit to an MUSC clinic) and the proportion of "missed opportunities. " A missed opportunity was when the patient presented to clinic for another reason and did not get a shot or simply did not show for their appointment. Comparisons were made between the same variable using chi-square.

Results Palivizumab was given to 24 patients in 2003-2004 and 31 patients in 2004-2005. For the year 2003-2004, 25% received the recommended number of injections. Forty-two percent of patients missed the shot at least 1 month. Seventeen percent made all of the opportunities for injection, and for the sample, there were 45 missed opportunities (35%). For the year 2004-2005, 71% received the recommended number of shots (p = .0005). Thirteen percent of patients missed the shot at least 1 month (p = .01). Seventy-four percent made all of the opportunities for injection (p = .0001), and for the sample, there were 11 missed opportunities (6%; p < .0001).

Conclusions Following a focused effort at improving compliance, a significant number of infants received the appropriate number of palivizumab doses and missed fewer opportunities for injections. Because data were examined retrospectively, the effect of individual interventions cannot be assessed.

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