The Joint Commission requires that pregnancy and lactation information for a patient must be accessible to practitioners who participate in the management of the patient’s medications. To facilitate this process, we developed computerbased decision support to collect and display pregnancy and breastfeeding information for female patients.
To screen for and document electronically the pregnancy and breastfeeding statuses of female patients to ensure that pregnancy and breastfeeding related safety concerns can be appropriately considered for prescribed medications.
A documentation and alerting module for pregnancy and breastfeeding statuses was implemented in the computerized provider order entry system at a 750bed tertiarycare academic medical center. Admitting clinicians are automatically presented with a screening form upon entering admission orders for female patients of ages 10 to 50 years. Clinicians are given options to enter breastfeeding and pregnancy statuses, to state that these statuses are unknown, or to order urine HCG testing (Fig 1). If an unknown status is selected for breastfeeding or pregnancy, the entry screen is presented to any clinician who accesses the order entry system two hours after the admission orders have been entered. If either an unknown breastfeeding or pregnancy status is again entered, clinicians are presented with the breastfeeding and pregnancy entry form once daily until a status is entered. Once completed, breastfeeding and pregnancy statuses are displayed in the order entry, inpatient pharmacy, and medication administration systems (Fig 2) to alert practitioners at each stage of the medication order and administration process. In the 8 months since implementation, pregnancy and breastfeeding statuses have been entered for 10,303 patients, including 714 pregnant and 1144 breastfeeding alerts of which 100 and 107, respectively, were for patients on nonobstetrical services where practitioners may be less likely to consider the pregnancy or breastfeeding status of their patients when ordering medications.
A pregnancy and breastfeeding screening and alerting system has been implemented successfully to improve medication safety. This workflow facilitates compliance with joint commission requirements and allows for electronic communication of this important information. The electronic documentation of pregnancy and breastfeeding statuses also provides a critical step towards developing decision support to alert clinicians when contraindicated medications are being ordered for pregnant or breastfeeding women.
To cite this abstract:Kachalia A, Miller A, Bane A, Stashek C, Poon E, Fiumara K, Cropp K, Carty M, D P, Boxer R. Improving Medication Safety for Pregnant and Breastfeeding Women Using Computerized Provider Order Entry. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97741. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/improving-medication-safety-for-pregnant-and-breastfeeding-women-using-computerized-provider-order-entry/. Accessed May 23, 2019.