Improving Clinic Workflow to Enhance Rubeola Immunity Screening in Pregnant Patients

Authors

• Courtney McDuffie, University of Texas Health Science Center at HoustonFollow

Date of Doctor of Nursing Practice Project Completion

2026

Faculty Advisor

Susan Stafford, DNP, MBA, MPA, RN-BC, NEA-BC

Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized the Measure, Analyze, Improve, Control (DMAIC) Framework. Interventions included provider engagement, individualized EMR order set modifications, visual cues, and audit-feedback cycles. Provider compliance with Rubeola serum IgG order entry and patient immunity identification served as primary outcome measures.

Results: During the post-intervention period, 448 Rubeola IgG orders were placed, yielding an estimated provider compliance rate of 45%. Weekly ordering increased throughout the intervention period, with the highest volume in the final weeks. More than 90% of patients were identified as immune to Rubeola.

Implications: Standardized workflows, provider engagement, and EMR-based interventions may improve providers' adherence to order-entry practices. These findings support the use of low-cost, sustainable strategies to enhance provider compliance with practice changes, identify Rubeola immunity status, and strengthen positive maternal health outcomes.

Keywords

order adherence, Rubeola immunity, obstetrics, documentation

Recommended Citation

Courtney McDuffie, "Improving Clinic Workflow to Enhance Rubeola Immunity Screening in Pregnant Patients" (2026). Doctor of Nursing Practice Final Project Abstract. 233.
https://digitalcommons.library.tmc.edu/dnp_abstract/233