Translating Research Evidence in Practice: Safety and Quality Innovation Towards Safe and Effective Vaccination Practice:
Postnatal Measles, Mumps and Rubella (MMR) - Vaccination for Woman Identified as Susceptible to Rubella Infection Following
Routine Antenatal Rubella Screening
Alison Evans RN Midwife MN (Clinical), Safety & Quality Consultant, Safety & Quality Unit, Tasmanian Health Organisation – South
Aim
To ensure safe and effective immunisation practices to include obtaining valid and
Informed consent for postnatal woman with serology identifying low or sero-negative
rubella titres with routine antenatal screening.
Quality Improvement
Woman - Centred Care
The outputs developed aimed to be directly linked to the outcomes for the initiative and
designed to be utilised by the health professional in the setting to ensure the success
of the outcomes.
The philosophy of health promotion is concerned with empowering people to make well
informed choices within the context of their culture and socio-economic background.
Objectives
To implement a system, and supportive resources, to ensure safe postnatal MMR
immunisation practice and a woman centred approach in the promotion of safe and
quality care within Maternity Services the Royal Hobart Hospital.
To implement an evidence based clinical protocol and supportive processes in order to
inform the health care team of their professional responsibility and accountability in safe
immunisation practices in line with national guidelines.
Midwifery and obstetric care aims to reflect family and community needs and
perspectives, while at the same time providing individualised care, to enable women to
take responsibility for their own health.
2011 - Evidenced based clinical protocol and associated documents/resources to guide and
inform changes in practice. Outputs and products produced were endorsed through requisite
organisational processes and include:
 STAHS - Consumer Information Brochure: Postnatal MMR Vaccination
There is strong evidence to support that good communication between healthcare
professionals and women is essential. Effective communication should be supported by
evidence-based, written information tailored to the woman's needs.
 STAHS - Postnatal MMR Vaccination Consent Form
 STAHS - Postnatal Measles, Mumps and Rubella (MMR) Vaccination Protocol
Specific information tools to inform and allow the acceptance of the process, with key content to
inform practice development and support change management:
NICE Clinical Guideline 62 – Antenatal Care p.7
 Postnatal MMR - Fast Facts for Health Professionals - Education
 Supportive Decision Making Tool - Specifically Designed Flow Chart - Visual Prompts
Understanding Safe and Quality
Vaccination Practice: Postnatal MMR
In 2011 an informal review of immunisation practices, both within the Royal Hobart
Hospital and a range of maternity services across Australia, identified:
Evaluation & Monitoring Systems
1; Current practice for the pre- administration of MMR vaccine for women, identified
as low or no immunity to rubella, did not require obtaining informed or written
consent as part of routine practice
2.: Lack of evidenced based or quality consumer information on postnatal MMR
vaccination promote woman centred care with attention to a woman’s needs,
values and preferences
Improvement in review process of antenatal serology
testing for rubella susceptibility to include
Improving Care: Utilising a Practice
Development Methodology
provision of consumer information on postnatal MMR vaccination
Improved understanding of professional and medico-legal responsibility
Medical Research Council (NHMRC) The Australian Immunisation Handbook, 9th ed. Canberra: Australian Government Publishing Service;
2008
prior to postnatal MMR vaccination undertake pre-screening to minimise
A facilitated practice development approach was adopted to link clinician-led innovation to the context of the
workplace and lead to the development and implementation of an evidence-based practice protocol.
Practice development is focused on person-centred clinical effectiveness, the delivery
of quality care and advancing the use of evidence-based approaches to care
risk of adverse event and obtaining informed & valid consent
Photo: DHHS Library
Transforming the contexts and cultures of care
Stakeholders
Consumers: Women
Multidisciplinary Team: Midwives, Medical Team
Safety & Quality Unit /RHH Practice Development Unit/RHH Medical
Legal Unit/PEHS - Communicable Disease Prevention
Public and Environmental Health Service/Serology Services
High level of compliance with protocol
Continuous improvement and systematic approach to effect changes
and completion of all postnatal MMR documentation
Applying evidence in practice and knowledge translation
Consumers & Informed Choice
Improved knowledge and skillls in
safe prescribing, vaccination practice and
The overall aim of health care is to deliver high quality care for all, all of the time. A range of
heath care literature suggests that the way a patient is treated as a person has for some time
been seen as a corner stone of quality.
recognition /management of anaphylaxis
Woman-centred maternity care has become a familiar phrase in today's maternity services,
however, the actual practice can be identified as more staff-centred than woman-centred.
Improved systems for vaccine
management and tracking for adverse events
The initiative aimed to promote evidence based practice that supports the value of a woman’s
preferences, beliefs and experience to inform clinical decision making.
Sharing Knowledge & Informing Practice
Informed and valid consent with good communication enhances interaction with the
healthcare team, supports responsive woman centred care and safer vaccination practice.
RHH Protocol adopted by THO North West implemented in Maternity Services
Overall, the initiative reflects the philosophy of midwifery, woman-centred care and evidence
based practice and gives priority to the wishes and needs of the user, and emphasises the
importance of informed choice.
Bibliography
“Immunisation gives a very good level of protection against many
serious diseases. It uses your body's natural defence mechanism –
the immune response - to build resistance to specific infection”.
PEH – DHHS Website http://www.dhhs.tas.gov.au/peh/immunisation
1.
Bergeson, S, & Dean J, 2006, ‘A systems approach to patient-centred care’, Journal of the
American Medical Association, vol.296, no.23, pp.2848-2849. Department of Health & Human
Services, Tasmania’s Health Professionals Leading the Way: Shaping Future Care Discussion
Paper Version 1.0 2009, ‘Leading the Way’ Taskforce, pp.1-55.
2.
Page, L & Percival, P 2000, The New Midwifery: Science and Sensitivity in Practice, Elsevier
Health Sciences, Churchill Livingston, pp.1 -7.
3.
The Department of Health and Human Services - Tasmanian Health Plan May 2007, viewed at 11
March 2009,
<http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0008/28484/HealthPlanSummary_nav.pdf>.
4.
Zwelling, E, Phillips, C 2001, ‘Family-Centered Maternity Care in the New Millennium: Is It Real or
Is It Imagined?’ The Journal of Perinatal & Neonatal Nursing, vol.15, no.3, pp.1-12.