A165: Implementing a Risk Education Strategy for Adolescent Girls Treated with Teratogenic Medications in the Pediatric Rheumatology Clinic

Background/Purpose: This quality improvement project was conducted to increase education and pregnancy screening for adolescent girls being treated with teratogenic medications in the pediatric rheumatology clinic. As nearly half of adolescents admit to sexual intercourse and one third of girls in the U.S. become pregnant before age 20, developing a strategy to address this need is a high priority. A recent initiative was developed and mandated by the FDA for educating women of reproductive age about the teratogenic effects of mycophenolate mofetil (Myophenolate REMS—Risk Evaluation and Mitigation Strategy). We aim to adapt the practices recommended by REMS to all girls of reproductive age prescribed teratogenic medications in our pediatric rheumatology clinic. Methods: The medical records of 29 consecutive female patients over the age of 10 who were taking medications with teratogenic potential were reviewed for documentation of teratogenicity education and pregnancy screening to establish our baseline practice. Interventions included education of the staff regarding our goal of applying REMS guidelines for education and pregnancy screening to all teratogenic medications, placement of visible reminders in clinic of the medications to be included in this project, and instruction of our nursing staff on identification of target patients during the intake process. Ongoing chart review was performed throughout the project to evaluate for improvement. Preliminary data were analyzed by chi square analysis, and as more data points become available, they will be plotted on a p chart to analyze improvement data over time. Results: At baseline, 11/29 (37.9%) of female patients over age 10 on teratogenic medications had education documented within the last 12 months, and 10/29 (34.4%) had pregnancy screening performed at the visit. Implementation of our interventions resulted in improvement in both documentation of ongoing teratogenicity education (15/27, 55.5%) and routine pregnancy screening (25/27, 92.5%), the latter of which showed statistical significance (p = 0.1865, <0.0001, respectively). Conclusion: The initial interventions made through this quality improvement project increased the frequency of teratogenicity education and pregnancy screening during routine follow-up in the pediatric rheumatology clinic. A clear improvement was made in urine pregnancy screening at clinic visits, revealing the recognition of teratogenic risk in these patients, and the acceptance of patients and families of this new testing process. However, the less robust improvement in consistent education documentation revealed more complex barriers that involve the electronic medical record, roles and responsibility for providing initial versus follow-up education, and the need for standardized educational processes. Ongoing work will focus on integration of this process into our clinic's work-flow, standardization of the education and documentation process among all providers and nurses, and incorporation of automatic reminders into the electronic medical record.