INTRODUCTION:
Low-dose aspirin (ASA) reduces the incidence of preeclampsia and related morbidity and mortality when given to pregnant patients at moderate to high risk of disease. The United States Preventive Services Task Force (USPSTF) provides clear guidelines for identifying patients who warrant a prescription for ASA; however, complexity of the algorithm may inhibit comprehensive screening and implementation. We aimed to implement a standardized approach to ASA screening and prescription in an academic obstetrics and gynecology practice.
METHODS:
Using a quality improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. Pre-intervention, we analyzed prescription adherence at 201 new obstetric (NOB) visits. A multistep intervention was then implemented. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factors or 2 or more moderate-risk factors. ASA orders were signed by physicians. Three months after implementation, 199 NOB visits were reviewed. The primary outcome was the percent of patients screened (goal=90%). The secondary outcome was the percent of patients who screened positive that received the ASA recommendation (goal=90%).
RESULTS:
Pre-intervention, 47% of patients met criteria for ASA, and 28% of those patients received a recommendation for ASA. Post-intervention, 99% were screened. Half (48%) met criteria for an ASA recommendation and 78% of those patients received a recommendation for ASA.
CONCLUSION:
It is feasible to standardize screening and implementation of ASA to patients at elevated risk for preeclampsia. Providers can easily reproduce our processes to improve delivery of reliable preventative obstetric care.
