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

Publication ,  Journal Article
Cooper, AM; Horwitz, M; Becker, ML
Published in: Pediatrics
April 2019

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.

Duke Scholars

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

April 2019

Volume

143

Issue

4

Location

United States

Related Subject Headings

  • United States
  • Tertiary Care Centers
  • Teratogens
  • Risk Assessment
  • Rheumatic Diseases
  • Prognosis
  • Pregnancy
  • Pediatrics
  • Patient Selection
  • Patient Education as Topic
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cooper, A. M., Horwitz, M., & Becker, M. L. (2019). Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic. Pediatrics, 143(4). https://doi.org/10.1542/peds.2018-0803
Cooper, Ashley M., Mara Horwitz, and Mara L. Becker. “Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic.Pediatrics 143, no. 4 (April 2019). https://doi.org/10.1542/peds.2018-0803.
Cooper AM, Horwitz M, Becker ML. Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic. Pediatrics. 2019 Apr;143(4).
Cooper, Ashley M., et al. “Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic.Pediatrics, vol. 143, no. 4, Apr. 2019. Pubmed, doi:10.1542/peds.2018-0803.
Cooper AM, Horwitz M, Becker ML. Improving the Safety of Teratogen Prescribing Practices in a Pediatric Rheumatology Clinic. Pediatrics. 2019 Apr;143(4).

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

April 2019

Volume

143

Issue

4

Location

United States

Related Subject Headings

  • United States
  • Tertiary Care Centers
  • Teratogens
  • Risk Assessment
  • Rheumatic Diseases
  • Prognosis
  • Pregnancy
  • Pediatrics
  • Patient Selection
  • Patient Education as Topic