Author(s): Nicole McCune, MSN, RN
Women Veteran Program Manager
VA Pittsburgh Healthcare System

Nicole graduated from Sewickley Nursing School in 1995, obtained her BSN from the University of Pittsburgh in 1998, and obtained an MSN from Waynesburg University in 2013. Nicole spent her entire twenty-seven-year nursing career at VA Pittsburgh. As a Women Veterans Program Manager since September 2020, she is committed to enhancing the quality of care of the Women Veterans she serves. She has in depth knowledge of high reliability and is a key promoter at her facility. She was instrumental in developing the first women's health substance use disorder care team and recently established an innovative reproductive health physician clinic.

Competency Domain: Patient Safety

Description: For prescribing teratogenic medications to women Veterans, although both the national pharmacy Teratogenic Medication warning and national guidance regarding teratogenic clinical reminders were implemented, process was not optimal as most medications were prescribed in the specialty setting and processes implemented were geared towards women's health only. From evaluating current processes and review of the national mandates related to teratogenic medication, streamlined documentation across specialties and a safety check when teratogenic medications were prescribed were implemented across VISN 4. The process update was disseminated widely and was monitored closely by the VISN 4 Primary Care ICC with successful compliance rates. Problem: Enhance the safety of prescribing teratogenic medication in women Veterans of child-bearing age. Measurement: Monthly compliance of a locally created dashboard and created control charts. Analysis: Deep dive into outliers and development of strategies to overcome outliers. Implementation: A standardized Teratogenic Medication Education Template was created and a flag to provider that the medication would not be filled unless the provider indicated that the Teratogenic Medication Education Template was complete in the medical record. Having a hard-stop with specific directions to guide providers allowed for buy-in and success. Results/Discussion7/9 sites in VISN 4 have maintained success of 90% or higher. Ongoing reporting, monitoring, and a group meeting to discuss the results has sustained the progress. Also sharing best implementation strategies among VISN 4 facilities to improve compliance rates of lower scoring facilities.

Evaluation: Complete Poster Evaluation