An Innovative Framework to Improve Teratogenic Medication Risk Counseling

• Published in: Journal of midwifery & women's health Vol. 62; no. 3; pp. 353 - 357
• Main Authors: Shroff, Swati, McNeil, Melissa, Borrero, Sonya
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2017
• Subjects: Birth control; Childbearing age; clinical reminder systems; Congenital diseases; Contraception; Contraceptives; Counseling; decision support systems; Drug Prescriptions; Drug therapy; Drugs; electronic health record; Electronic Health Records; Family Planning Services; Female; Guidelines; Humans; medical order entry systems; Patient communication; Patient education; Pennsylvania; Pharmacists; Physicians, Primary Care; Practice Patterns, Physicians; Prescribing; Primary care; Quality control; Quality improvement; Referral and Consultation; Reminder Systems; Reproduction; Risk; Risk factors; Side effects; Teratogens; United States; United States Department of Veterans Affairs; Veterans; Women; Womens health; United States > US; counseling; quality improvement; teratogens; clinical reminder systems; risk; electronic health record; medical order entry systems; decision support systems
• ISSN: 1526-9523; 1542-2011
• DOI: 10.1111/jmwh.12604

Health care providers in the Veterans Affairs system are caring for a growing number of women of childbearing age. Prior research shows that a significant number of women veterans are prescribed category D or X teratogenic medications. However, the majority do not receive teratogenic risk or contraceptive counseling. In order to improve teratogenic medication prescribing practices at the Veterans Affairs Pittsburgh Healthcare System, we developed a framework called TARCC to guide primary care providers through appropriate teratogenic risk counseling. The components of TARCC are teratogen (Are you prescribing a potential teratogen?), alternative (Did you consider a nonteratogenic alternative?), risks (Did you discuss the risks of the medication?), contraception (Did you discuss contraception?), and chart (Did you chart your discussion?). We incorporated TARCC into an electronic health record reminder. Additional probes, educational tools, and options to place consults and orders are included within the reminder. The Teratogen Pharmacy E‐consult prompts a pharmacist to electronically review a patient's medications and provide recommendations regarding potential alternatives and discussions of risks and benefits. This article describes the development and implementation of the TARCC framework in a clinical reminder.