Division of Rheumatology,
Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
Pediatrics. 2019 Apr;143(4). doi: 10.1542/peds.2018-0803. Epub 2019 Mar 5.
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.
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.
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 ( < .0001). Control charts revealed special cause with sustained improvement over >1 year.
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.
尽管有许多致畸药物被广泛用于治疗风湿性疾病，但目前尚无标准模型用于向青少年患者教育致畸风险或进行常规妊娠筛查。我们进行了一项质量改进项目，以增加我们儿科风湿病诊所中使用致畸药物的育龄女性患者的教育和妊娠筛查。
合格的参与者包括在单中心三级保健儿科风湿病诊所中接受致畸药物治疗的 10 岁及以上的女性患者。共完成了 7 个计划-执行-研究-行动周期，以测试以下干预措施：可视项目提醒、医生和护士教育、进度更新、就诊前计划以及电子健康记录教育模板的开发。进行了图表审查，并为每个目标创建了控制图表，以分析随时间的改进情况。
基线时，在接受致畸药物治疗的年龄在 10 岁及以上的女性患者的 231 次就诊中，有 57 次（24.7%）在过去 12 个月内记录了教育内容，有 47 次（20.3%）在就诊时进行了妊娠筛查。我们干预措施的实施导致年度致畸剂教育记录（1135 例中的 904 例；79.6%）和常规妊娠筛查（1135 例中的 940 例；82.8%）均有所改善，这两项均具有统计学意义（<.0001）。控制图表显示，经过 1 年以上的时间，特殊原因导致持续改善。
通过这个质量改进项目实施的干预措施增加了接受致畸药物治疗的患者接受致畸风险教育和尿液妊娠筛查的频率。在电子健康记录中开发标准化教育模板在维持这些改进方面发挥了关键作用。
