Shroff Swati, McNeil Melissa, Borrero Sonya
J Midwifery Womens Health. 2017 May;62(3):353-357. doi: 10.1111/jmwh.12604. Epub 2017 May 9.
Health care providers in the Veterans Affairs system are caring for a growing number of women of childbearing age. Prior research shows that a significant number of women veterans are prescribed category D or X teratogenic medications. However, the majority do not receive teratogenic risk or contraceptive counseling. In order to improve teratogenic medication prescribing practices at the Veterans Affairs Pittsburgh Healthcare System, we developed a framework called TARCC to guide primary care providers through appropriate teratogenic risk counseling. The components of TARCC are teratogen (Are you prescribing a potential teratogen?), alternative (Did you consider a nonteratogenic alternative?), risks (Did you discuss the risks of the medication?), contraception (Did you discuss contraception?), and chart (Did you chart your discussion?). We incorporated TARCC into an electronic health record reminder. Additional probes, educational tools, and options to place consults and orders are included within the reminder. The Teratogen Pharmacy E-consult prompts a pharmacist to electronically review a patient's medications and provide recommendations regarding potential alternatives and discussions of risks and benefits. This article describes the development and implementation of the TARCC framework in a clinical reminder.
退伍军人事务系统中的医疗服务提供者正在照料越来越多的育龄女性。先前的研究表明，相当数量的女性退伍军人被开具了D类或X类致畸药物。然而，大多数人并未接受致畸风险或避孕咨询。为了改善匹兹堡退伍军人事务医疗系统中致畸药物的处方开具做法，我们开发了一个名为TARCC的框架，以指导初级保健提供者进行适当的致畸风险咨询。TARCC的组成部分包括致畸原（你正在开具一种潜在的致畸原吗？）、替代药物（你考虑过非致畸性替代药物吗？）、风险（你讨论过药物的风险吗？）、避孕（你讨论过避孕问题吗？）以及记录（你记录了你的讨论吗？）。我们将TARCC纳入了电子健康记录提醒中。提醒中还包括额外的询问、教育工具以及进行会诊和开医嘱的选项。致畸药物药房电子会诊会促使药剂师以电子方式审查患者的用药情况，并就潜在的替代药物以及风险和益处的讨论提供建议。本文介绍了TARCC框架在临床提醒中的开发和实施情况。
