Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic.

Document Type

Article

Publication Date

4-2019

Identifier

DOI: 10.1542/peds.2018-0803

Abstract

Objectives: Although teratogenic medications are commonly used to treat rheumatic disease, no standard model currently exists for educating adolescent patients about teratogenic risk or performing routine pregnancy screening. We performed a quality improvement project to increase education and pregnancy screening in girls and women of childbearing age prescribed teratogenic medications in our pediatric rheumatology clinic.

Methods: Eligible participants included female patients age 10 and older prescribed teratogenic medications in a single-center tertiary care pediatric rheumatology clinic. Seven plan-do-study-act cycles were completed to test the following interventions: visible project reminders, physician and nurse education, progress updates, previsit planning, and development of an electronic health record education template. Chart reviews were performed, and control charts were created for each aim to analyze improvement over time.

Results: At baseline, 57 of 231 (24.7%) clinic encounters of female patients age 10 years and older taking teratogenic medications had education documented within the last 12 months, and 47 of 231 (20.3%) had pregnancy screening performed at the visit. Implementation of our interventions resulted in improvement in documentation of annual teratogen education (904 of 1135; 79.6%) and routine pregnancy screening (940 of 1135; 82.8%), both of which were statistically significant (P < .0001). Control charts revealed special cause with sustained improvement over >1 year.

Conclusions: The interventions made through this quality improvement project increased the frequency of both teratogen education and urine pregnancy screening in patients taking teratogenic medications. Development of a standardized education template in the electronic health record played a key role in sustaining these improvements over time.

Journal Title

Pediatrics

Volume

143

Issue

4

MeSH Keywords

Abnormalities, Drug-Induced; Adolescent; Ambulatory Care; Antirheumatic Agents; Child; Cohort Studies; Drug Prescriptions; Electronic Health Records; Female; Hospitals, Pediatric; Humans; Monitoring, Physiologic; Patient Education as Topic; Patient Selection; Pregnancy; Prognosis; Rheumatic Diseases; Risk Assessment; Teratogens; Tertiary Care Centers; United States

Keywords

Abnormalities, Drug-Induced; Adolescent; Ambulatory Care; Antirheumatic Agents; Child; Cohort Studies; Drug Prescriptions; Electronic Health Records; Female; Hospitals, Pediatric; Humans; Monitoring, Physiologic; Patient Education as Topic; Patient Selection; Pregnancy; Prognosis; Rheumatic Diseases; Risk Assessment; Teratogens; Tertiary Care Centers; United States

Link to Full Text
Library Record

Share

COinS