Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Karen Weis


The health care system in the United States has been described as having a deficit in care for women during pregnancy (IOM, 2019), and as a result there has been a resurgence over the last decade in diseases like pertussis, which is a severe respiratory infection that is particularly dangerous for infants less than 3 months of age (Tan & Gerbie, 2013). The primary objective of this project was to implement a Tdap vaccination program and increase the rates of Tdap vaccinations of obstetrical patients at a San Antonio clinic. The intervention included: 1) establishing standing orders for the Tdap vaccination, 2) encouraging physician recommendation of the vaccination to every pregnant patient (with each pregnancy), and 3) providing educational materials on the safety and benefits of the Tdap vaccination. Between February 3 – May 3, 2020, the clinic provided care to 338 obstetrical patients. All received a physician recommendation for the Tdap vaccination and were given further educational information at their initial prenatal appointment. Two-hundred and seven patients (59.2%) were eligible for vaccination (27-36 weeks’ gestation) and received Tdap recommendations prior to vaccination (mean gestational age was 29 weeks). Ten women (5%) declined the Tdap vaccine after recommendation. Establishing an evidence-based process for Tdap vaccination ensured 100% of eligible patients were given recommendations and were offered the vaccination between 27-36 weeks of pregnancy. Ultimately, the combination of implementing standing orders within the host health center, securing a physician recommendation, and increasing patient and staff education influenced an increase in the Tdap vaccination in obstetrical patients.