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 females55 years with an intact uterus and ovaries who are not postmenopausal. A retrospective systematic sample between 1/2022 and 6/2022 demonstrated that 17% (5/30) of eligible patients underwent pregnancy testing within 7 days of starting chemotherapy. Staff education was sent out 08/2022 to multidisciplinary team members. An automated nudge in the electronic health record (EHR, Epic) was added to prompt guideline concordant pregnancy testing at the time of chemotherapy treatment plan ordering. The EHR was set to assess guideline parameters and automatically add pregnancy testing to the labs section of each cycle if criteria met. A systematic sample of 20 eligible patients was assessed monthly for compliance. Results: Among 20 assessed eligible patients per month, an average of 16 pregnancy tests were administered, an increase from baseline 17% compliance to 80% sustained over a 8 month period. Of the 160 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. The Quality Department will continue with Pregnancy Testing audits quarterly as a quality assurance activity, and rates of compliance will continue to be reported through the Hem/Onc Quality Committee. This approach demonstrates feasibility of achieving NCCN and QOPI standards while tailoring the intervention to patients of childbearing potential.