Authors :
Presenting Author: Kimberly Ndahayo, DNP, FNP-C, CNRN – University of Colorado School of Medicine
Ashley Affentranger, DNP, APN, AGPCNP-BC – Instructor, Neurology, Epilepsy, University of Colorado School of Medicine; Teresa Connolly, PhD, RN, ACNS-BC – Assistant Professor, University of Colorado College of Nursing; Jennifer Simpson, MD – Associate Professor, Neurology, University of Colorado School of Medicine; Jacob Pellinen, MD – Assistant Professor, Neurology, University of Colorado School of Medicine
Rationale: For women with epilepsy, there is an increased risk of complications, including pregnancies that result in neural tube defects and autism, associated with the use of anti-seizure medications. Folic acid plays a role in decreasing this risk, especially with supplementation during the first six weeks of pregnancy. Many women are unaware of their pregnancy until well into the first trimester, and those with epilepsy have a higher risk of unplanned pregnancies than the general population (Herzog et al., 2017). This often results in missing the critical window for reducing complications due to folic acid deficiency early in pregnancy. The aim of this quality improvement initiative was to increase folic acid prescription rates from 18% to 50% for women with epilepsy of childbearing age between ages 18 and 47 seen at our level four academic epilepsy center.
Methods:
Data from electronic medical records (EMR) was obtained for women meeting inclusion criteria and was analyzed using descriptive statistics utilizing confidence intervals and the eight point run chart rules for the aim. Baseline data was collected from January through June 2022, identifying 1,032 patients meeting inclusion criteria. Interventions began July 1st, 2022 and concluded March 1st, 2023 during which time 1,252 patients met inclusion criteria. Four PDSA cycles were conducted during the intervention phase including provider education, additional EMR screening tool, patient educational flyers and provider data reporting to target specific identified barriers.
Results: The aim of this QI initiative, to increase folic acid prescription rates for women with epilepsy of childbearing, was partially met with an increase from a baseline of 17.37% to 35.03% folic acid prescriptions. Data points for folic acid prescribing demonstrated a shift in prescribing rates with steady increase throughout the intervention phase, indicating that interventions were creating system-wide change in practice. Provider awareness of individual prescribing habits along with re-education interventions seemingly had the largest impact in improving prescribing rates of folic acid. Additionally, the first process measures, provider education, exceeded the goal with 100% of providers receiving education. The second process measure, utilization of the created EMR screening tool, reached a final utilization rate of 25.38%. The balancing measure exceeded the goal, revealing no perceived negative impacts to clinic workflow.
Conclusions:
Our quality improvement initiative shows that increasing provider education and awareness increases folic acid prescribing rates for women with epilepsy of childbearing age with no negative impact to clinic workflow. This study highlights the importance of provider education as well as ongoing monitoring of folic acid prescribing rates to improve patient outcomes and identifies a series of interventions that can be replicated and further studied in a variety of clinical settings.
Funding: There was no targeted funding for this study.