University of Florida, Gainesville, FL
Brittany Kayla Rogers, Merry Jennifer Markham
Background: Screening appropriate female patients of childbearing potential for pregnancy prior to cancer therapy is crucial, but who and when to screen is unclear. Prior institutional data revealed low screening rates (35% of eligible women, with medical oncology performing 7% of screening) and less than half within two weeks of treatment. A QI intervention was implemented in the outpatient infusion center by adding screening to the infusion nurses’ (IC RN) pre-chemo checklist. If a patient was deemed eligible for screening, the RN could utilize a standing order for a urine pregnancy test. Following intervention, screening rates for medical oncologists improved but remained low (30.6%). Methods: A second PDSA cycle was initiated by surveying medical oncologists and IC RNs on screening practices and perceived barriers. Results: Survey response rates were 42.8% (9/21) for IC RNs, 53.3% (8/15) for oncologists. 50% of oncologists felt the screening age should be 18-50 vs. 37.5% for 18-45 vs. 12.5% for 18-55. 50% of medical oncologists felt that screening should occur the same day of chemo. Only 12.5% of oncologists reported "always" verifying a negative test prior to chemo, with 37.5% verifying "most", 25% “half", and 25% verifying "some” of the time. 62.5% of oncologists felt menopause should be an exclusion. 100% of IC RNs felt a negative test should be obtained the same day. 87.5% of IC RNs "always" confirm a negative test before chemo. Most IC RNs felt menopause should an exclusion (75%) and this would not increase IC RNs’ workload (87.5%). The barriers for screening are reported below. Conclusions: This survey was useful to identify barriers in our pregnancy screening QI initiative. Clearly defining patients (age 18-50), time frame for screening (same day) and excluding for menopause are manageable changes to decrease nurse workload and increase rates closer to our goal of 80%. Modification of the IC RN checklist will occur based on these results.
Barriers to Screening | % Oncologists | % Infusion Nurses |
---|---|---|
Infusion nurse workload | 62.5 | 50 |
Unclear time frame needed | 62.5 | 12.5 |
Patient reluctance | 25 | 50 |
Difficulty identifying appropriate patients | 37.5 | 12.5 |
Time required | 25 | 25 |
Work required | 12.5 | 0 |
Lack of oncologist “buy-in” | 25 | 0 |
Lack of infusion nurse “buy-in” | 0 | 12.5 |
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Abstract Disclosures
2019 ASCO Annual Meeting
First Author: Natalie S Berger
2024 ASCO Quality Care Symposium
First Author: Carlos U. Muzlera
2017 ASCO Quality Care Symposium
First Author: Brittany Kayla Rogers
2023 ASCO Quality Care Symposium
First Author: Mary Yousef