Winner of the 2013 David Calkins Memorial Scholarship

Brandon Lynch, a Preventive Medicine resident at Oregon Health and Science University and public health student at Portland State University, is the winner of this year’s David Calkins Memorial Scholarship, earning him a free trip to the National Forum. The scholarship, which is awarded to one full-time health professions student every year, includes a free registration to the Forum and $1,000 for travel and lodging. 

A panel of judges, including Susan Rice, David Calkins’ widow, and their son, Chris, chose Lynch’s winning essay – about improving his hospital’s Hepatitis B vaccine birth dose rate – from dozens of excellent candidates. 

David Calkins (May 27, 1948 – April 7, 2006), MD, MPP, was a physician, teacher, IHI Fellow, and health care improvement champion who was a member of IHI’s 100,000 Lives Campaign team​. He was also an Associate Professor of Medicine at Harvard Medical School and Associate Physician at Massachusetts General Hospital. 

Here is Lynch’s scholarship-winning essay:

In the fall of 2012, the state of Oregon shared our Hepatitis B vaccine birth dose rate with Oregon Health and Science University leadership. Our rate of 56% was nearly 15% lower than the state average of 70%. Even in the vaccine averse culture of the Pacific Northwest this was an alarming opportunity for improvement. The rate, we decided, was an important and suitable measure to follow given it is a good predictor of completion of the vaccine series which, in turn, is the main intervention to prevent hepatitis B morbidity and mortality in the United States. Furthermore, the rate was easy to follow as it was already reported by the state. Our aim was to reach the regional standard by the end of 2013.

We began by polling the providers, nurses and patients we encountered in the newborn units of the hospital regarding their attitudes towards this decreased rate. What we found were varying degrees of ambivalence towards the importance of vaccination with many who deferred it to the outpatient setting in lieu of more pressing inpatient matters. The solution, we posited, was to educate the hospital community about our rate and the importance of the hepatitis B birth dose. 

For the education campaign I created a colorful flier and posted it in high traffic areas where providers, nurses, and patients could see our rate compared to the state average. In addition, I presented our improvement campaign throughout the hospital, including our institution’s multidisciplinary maternity grand rounds where it was energetically discussed by nurses and providers involved in maternity care. While the campaign was met with some resistance to change, the result was an enthusiastic and engaged workforce… and a rate that continued at 55%. 

We next tackled our vaccine administration process. First, as a group, we mapped out the birth process from initial prenatal visit to hospital discharge. We compared the process to those of our regional competitors and noted that many administered the vaccine on Labor and Delivery in conjunction with vitamin K and erythromycin. Ours was given just prior to discharge, where it was easy to defer to the outpatient setting. Over the course of the year we collaborated with our pharmacy colleagues to have the vaccine available on L&D and met with nursing staff on the unit in order to encourage its administration shortly after birth. On August 6th, 2013 the nursing driven process implementation went live. Although the change has not been without challenges it has been effective: our preliminary data suggest that our rate is now equal with that of our Portland peers. 

Now with a rate of 70% the benchmark has been moved. We have our sights set on the Immunization Action Coalition Hepatitis B Honor Roll, necessitating a 90% or higher rate over the course of a year. Partnering next with our patients our hope is to break down barriers to vaccination and be the first hospital in vaccine averse Oregon to make the list.
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