For prescribing teratogenic medications to women Veterans, although both the national pharmacy Teratogenic Medication warning and national guidance regarding teratogenic clinical reminders were implemented, process was not optimal as most medications were prescribed in the specialty setting and processes implemented were geared towards women’s health only. From evaluating current processes and review of the national mandates related to teratogenic medication, streamlined documentation across specialties and a safety check when teratogenic medications were prescribed were implemented across VISN 4. The process update was disseminated widely and was monitored closely by the VISN 4 Primary Care ICC with successful compliance rates.
Problem: Enhance the safety of prescribing teratogenic medication in women Veterans of child-bearing age.
Measurement: Monthly compliance of a locally created dashboard and created control charts.
Analysis: Deep dive into outliers and development of strategies to overcome outliers.
Implementation: A standardized Teratogenic Medication Education Template was created and a flag to provider that the medication would not be filled unless the provider indicated that the Teratogenic Medication Education Template was complete in the medical record. Having a hard-stop with specific directions to guide providers allowed for buy-in and success.
Results/Discussion: 7/9 sites in VISN 4 have maintained success of 90% or higher. Ongoing reporting, monitoring, and a group meeting to discuss the results has sustained the progress. Also sharing best implementation strategies among VISN 4 facilities to improve compliance rates of lower scoring facilities.
