Evaluations of the pilot phase using the North Carolina Immunization Registry (NCIR) for babies in the Newborn Critical Care center at NC Children’s Hospital revealed several learning and improvement opportunities. The nursery is a large service admitting more than 700 patients a year. Initial unit training included both the nursing staff and the unit clerks; however the opportunity to use the registry was not frequent enough to maintain competency among a large group. The unit is trialing using a smaller group of nurses to enter the information into NCIR. Additionally, the potential for duplicate records was increased because often patient names were not reconciled at discharge. The unit is trialing delayed entry into the registry until the legal name is verified. These examples of small tests of change will create a system that is robust and reproducible.