Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Julie A. Koch


Despite the availability of a preventive vaccine, the incidence of pertussis in the United States has continued to increase over the past two decades and it is now considered the most common preventable infectious illness. Highly contagious in nature, it is estimated that about 50 million people are infected each year, and approximately 300,000 deaths occur worldwide (Centers for Disease Control and Prevention [CDC], 2012). In 2013, Indiana reported 616 cases (Indiana State Department of Health [ISDH], 2014). In spite of CDC recommendations on strategies that can improve vaccine delivery, rates of immunization remain low nationwide (CDC, 2014). The purpose of this evidence-based practice project was to determine if implementation of a multifaceted intervention that consisted of provider reminder and education, and standardization of Tdap vaccine delivery would increase vaccination rates among women aged 18 years and older. The Iowa Model of Evidence-based Practice and Kurt Lewin’s change theory were utilized for guidance to facilitate the transition of best evidence into practice. Within a women’s health clinic in Northern Indiana, a retrospective chart review was conducted prior to project implementation followed by a ten-week period during which provider education, provider prompts attached to charts of eligible patients, and a standardized protocol for vaccine delivery was introduced. A five-fold increase in immunization receipt was noted with 1.5% (n = 5) immunized pre-intervention, compared to 11.7% (n = 31) immunized during intervention; results revealed a statistically significant association between the intervention and vaccine receipt (X2= 26.555, p < .0001). Additionally, chi-square was used to analyze variables of interest including age, ethnicity, type of visit (obstetric, post-partum, well visit or acute visit), and type of insurance coverage, which were examined to determine whether they affected vaccination receipt. Findings revealed that none of the variables significantly influenced the rate of immunization among the women. Results of this EBP project lend support to the recommendation of use of this multifaceted approach as a strategy to increase rate of immunizations.