Clinical program manager Cleveland Clinic Children's Peninsula, Ohio, United States
Title: Increasing Compliance with Pregnancy Testing Prior to Antineoplastic Therapy
Abstract : It was identified in late 2023 that our oncology department was having challenges assessing female patients for pregnancy prior to administration of antineoplastic therapy. An initial review of data in early 2024 revealed that among females of reproductive age receiving antineoplastic treatment for pediatric cancers, we had only screened for pregnancy in 32% of treatments. Recommendations from the American Society of Clinical Oncology are to develop institutional standards and practices for testing, which we did not have.
The purpose of this project was to create reliable interventions that would increase hCG testing prior to antineoplastic therapy in menstruating females.
Using the Institute for Healthcare Improvement model for improvement, a Failure Effects Mode Analysis (FMEA) was drafted to determine where we needed to improve our processes. We looked at all patients that were getting antineoplastic therapy in the outpatient an inpatient setting. Based on the results of the FMEA, a Key Driver Diagram with aims and interventions was developed to guide our team through implementation, with a smart aim to increase compliance with pregnancy testing prior to initiating antineoplastic therapy in female patients 10 years and greater from 32% to 100% by Feb 28, 2025. Multiple PDSA cycles ensued, and interventions were revised or abandoned before determining the most successful interventions to meet our goal. Aside from awareness and education, our greatest intervention was development of a departmental policy for assessing pregnancy.
After a robust literature review, we found that having a policy was the general recommendation, but no guidance was given. Our nursing team carved a document of who, how, and when patients would be assessed for pregnancy. Post completion of the interventions, we were 100% compliant and identified an unknown pregnancy in a patient on a MEK inhibitor which would have otherwise gone undetected.
