Developing and implementing a formal pregnancy screening policy prior to systemic cancer treatment: a quality improvement project

Abstract

Background: Systemic anticancer therapies are essential to cancer treatment but pose significant teratogenic risks when administered during pregnancy, particularly during the first trimester. Pregnancy screening prior to systemic therapy remains inconsistent nationwide, with reported screening rates as low as 17-20%. In June 2025, the Quality Oncology Practice Initiative (QOPI) introduced standards requiring formal pregnancy screening policies and documentation before initiation of systemic therapy. Local Problem: This QOPI-certified cancer center lacked a formal pregnancy screening policy, increasing the risk of an adverse event. Purpose: This quality improvement project aimed to implement a standardized pregnancy screening policy and achieve 100% compliance among patients of childbearing potential aged 18-50 receiving systemic cancer therapy at a comprehensive cancer center in south-central Montana. Methods/Intervention: Guided by the Plan-Do-Study-Act framework, a pregnancy screening policy was integrated into electronic health record workflows including modifying treatment plans and infusion checklists, creating standing orders, and standardizing documentation. Staff and provider education and multidisciplinary collaboration supported workflow refinement. Weekly retrospective chart audits monitored compliance for patients receiving intravenous, subcutaneous, or oral systemic cancer therapy over 7 weeks. Results: At baseline, no eligible patients had documented pregnancy screenings (0%). After three PDSA cycles, missed screenings decreased from 100% (0) to 59% (24/41) among eligible infusion patients and from 100% (0) to 65% (11/17) among eligible oral therapy patients. Conclusion: Standardized pregnancy screening improved compliance with QOPI standards, but workflow barriers remain. Ongoing audit, education, and process refinement are required to sustain safe patient care.