Reliable Pregnancy Testing Before Intravenous Cyclophosphamide: A Quality Improvement Study

Area of Science:

• Pediatric Rheumatology
• Adolescent Medicine
• Clinical Quality Improvement

Background:

• Cyclophosphamide is a teratogenic medication used for adolescent autoimmune disorders.
• Sexually active adolescents on this treatment often lack adequate contraceptive care, increasing unintended pregnancy risk.
• A quality improvement initiative was implemented to enhance pregnancy screening.

Purpose of the Study:

• To improve the rate of pregnancy testing prior to intravenous cyclophosphamide administration in adolescent females.
• To establish a standardized protocol for pregnancy screening in this vulnerable population.

Main Methods:

• A quality improvement project utilizing an iterative approach.
• Data collected from electronic medical records for girls aged 12-21 years (July 2011-June 2015).
• Interventions included staff education, electronic order set updates, and a Maintenance of Certification project; interrupted time series analysis was used.

Main Results:

• Pregnancy testing rates increased from 25% to 100% by the study's end.
• Infusions were significantly more likely to include a pregnancy test in the final period (OR 17.7, 95% CI 3.1-101.6).
• Adjustments were made for patient age, service, setting, and insurance type.

Conclusions:

• A significant improvement in standard pregnancy screening was achieved.
• Key interventions included electronic order set updates, staff education, and physician engagement.
• The initiative successfully enhanced patient safety for adolescents receiving cyclophosphamide.