Lupus & antiphospholipid syndrome
A quality improvement project to incorporate the mycophenolate Risk Evaluation and Mitigation Strategies in an academic lupus clinic
Authors' conclusion
Using quality improvement cycles, we incorporated a two-part MREMS protocol into a busy academic lupus clinic, with improved documentation and pregnancy screening.
Study context
- Population
- Adult female Systemic Lupus Erythematosus (SLE) patients aged 18–50 on MMF, excluding those with hysterectomy, academic lupus clinic, February 2023 to May 2024
- Participants
- 89 eligible encounters
- Comparison
- Before vs after a multicomponent intervention to implement the mycophenolate REMS protocol
- Outcome
- Documentation of the MREMS protocol in the encounter clinic note (goal: from 0% to 75%)
- Follow-up
- Within 14 months
Methodological detailssingle-centre, PDSA cycles, control charts, one-year post-implementation follow-up
- Single-centre
- PDSA cycles
- Control charts
- One-year post-implementation follow-up
Main finding
As reported in the abstract
Mycophenolate Risk Evaluation and Mitigations Strategies (MREMS) documentation, baseline
0%
MREMS documentation, average during first 8 months of PDSA cycles
24%
MREMS documentation, average after shift
67%
Documentation goal reached and sustained for the last three consecutive months
75%
Further findings
Pregnancy-test ordering
- Rose from 0% to
- 63%
Contraception documented
- Proportion of visits
- 98%
MREMS documentation and pregnancy screening · 1 year after intervention
- Remained above 75% of encounters
Safety
Pregnancies exposed to MMF · over the course of the intervention
- No pregnancies exposed to MMF
Original publication
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