Standardization of pregnancy screening prior to chemotherapy: A quality improvement project.

Abstract

e18702 Background: Administering chemotherapy during pregnancy is considered a serious adverse event, especially during the first trimester. NCCN and QOPI Certification program standards require assessing and documenting pregnancy status for women of childbearing age before first administration of a new chemotherapy regimen. However, guidelines and policies lack standardization on patient selection. We aimed to understand and address barriers to pregnancy testing prior to initiation of chemotherapy at a large regional cancer center. Methods: An institutional guideline was developed recommending a qualitative serum beta hCG test prior to each chemotherapy cycle (≥21 days apart) for females ≤ 55 years with an intact uterus and ovaries who are not postmenopausal. A retrospective chart review between 1/2022 and 6/2022 using systematic sampling and the above algorithm revealed a baseline compliance of 17% (5/30) of patients undergoing a pregnancy test within 7 days of starting chemotherapy. In an effort to improve compliance, the guideline and educational email was sent out 08/2022 to medical oncologists, nurse educators, nurse navigators, and pharmacists. An automated nudge in the electronic health record (Epic) was added to prompt guideline concordant pregnancy testing at the time of chemotherapy treatment plan ordering. Assessments were conducted at the end of each month by systematic sampling of 20 eligible patients. Compliance was determined according to institutional guideline. Results: Among 20 assessed eligible patients per month, an average of 15.75 pregnancy tests were administered, an increase from baseline 17% compliance to 76% sustained over a 5 month period. Of the 100 cases abstracted, no pregnancies were detected. Conclusions: Electronic health record nudge in conjunction with institutional guideline and education, led to an increase in appropriate pregnancy testing prior to initiation of chemotherapy. This approach demonstrates feasibility of achieving NCCN and QOPI standards while tailoring the intervention to patients of childbearing potential. [Table: see text]