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

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.

A Quality Improvement Approach to Improving Discharge Documentation

“…Continued optimization and hard-stop requirements may help to mitigate these errors. Other studies have shown the potential of pediatric EHR-based templates and dot-phrases to improve written provider handoffs, 6,33 documentation and timing of neurovascular exams, 34 documentation of gun safety discussion during well child care, 35 documentation of patient-focused teratogen education, 36 and documentation of inpatient disposition recommendations related to children admitted with diabetic ketoacidosis. 37 Provider-focused EHR education can lead to improved quality, readability, and accuracy of documentation, as well as fewer medical errors.…”

Technology-Enabled and Artificial Intelligence Support for Pre-Visit Planning in Ambulatory Care: Findings From an Environmental Scan

“…Less common were activities on the day of an appointment, though key informants indicated that they thought huddling was likely more common than reported in studies, suggesting that some PVP practices may be routine and not described as part of an innovative practice change. Pre-visit planning practices identified in the literature mostly encompassed 2-3 16,[18][19][20][21][22]24,25,[28][29][30][31][32][33] of the AMA's 10 steps while 5 studies reported just 1 activity (though these were substantive efforts to prepare the patient for a productive visit), 15,26,[34][35][36][37] and 9 studies reported 4 or more steps, 5,17,23,27,38,[39][40][41][42] with 8 being the most steps reported in 1 article. 5 Pre-visit planning seems to be used primarily to ensure that health maintenance is up to date, current laboratory data are available, and patients have set priorities for their visit.…”