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Research ArticleOther Arthritides

Improving Hydroxychloroquine Dosing and Toxicity Screening at a Tertiary Care Ambulatory Center: A Quality Improvement Initiative

Sahil Koppikar, Stephanie Gottheil, Chandra Farrer and Natasha Gakhal
The Journal of Rheumatology January 2021, 48 (1) 138-144; DOI: https://doi.org/10.3899/jrheum.191265
Sahil Koppikar
1S. Koppikar, MD, FRCPC, C. Farrer, PT, MSc, N. Gakhal, MD, MSc, FRCPC, Division of Rheumatology, University of Toronto, and Division of Rheumatology, Women’s College Hospital;
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  • ORCID record for Sahil Koppikar
  • For correspondence: sahil.koppikar@wchospital.ca
Stephanie Gottheil
2S. Gottheil, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
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Chandra Farrer
1S. Koppikar, MD, FRCPC, C. Farrer, PT, MSc, N. Gakhal, MD, MSc, FRCPC, Division of Rheumatology, University of Toronto, and Division of Rheumatology, Women’s College Hospital;
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Natasha Gakhal
1S. Koppikar, MD, FRCPC, C. Farrer, PT, MSc, N. Gakhal, MD, MSc, FRCPC, Division of Rheumatology, University of Toronto, and Division of Rheumatology, Women’s College Hospital;
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Abstract

Objective. Hydroxychloroquine (HCQ) is a commonly used weight-based medication with a risk of retinal toxicity when prescribed at doses above 5 mg/kg/day. The objectives of our study were (1) to characterize the frequency of inappropriate HCQ dosing and retinopathy screening, and (2) to improve guideline-based management by implementing quality improvement (QI) strategies.

Methods. A retrospective chart review was performed to obtain baseline analysis of HCQ dosing, weight documentation, and retinal toxicity screening to characterize current practices. The primary aim was to increase the percentage of patients appropriately dosed from 30% to 90% over a 10-month period. The secondary aim was to increase the percentage of documented retinal screening from 59% to 90%. The process measure was the number of patients with a documented weight in the chart. The balancing measure was the physician’s perceived increase in time spent with each patient due to implemented interventions. QI methodology was used to implement sequential change ideas: (1) HCQ weight-based dosing charts to facilitate prescription regimens; (2) addition of scales to patient rooms to facilitate weight documentation; and (3) electronic medical record (EMR) “force function” involving weight documentation and autodosing prescription.

Results. The percentage of patients being weighed increased from 40% to 92% after 10 months. Appropriate HCQ dosing improved from 30% to 89%. Retinal screening documentation improved by 33%.

Conclusion. Dosing charts in clinic rooms, addition of weight scales, and EMR force function autodosing prescriptions significantly improved appropriate HCQ dosing practices. These interventions are generalizable and can promote safe and guideline-based care.

Key Indexing Terms:
  • disease-modifying antirheumatic drugs
  • hydroxychloroquine
  • quality improvement
  • quality of care
  • retinal toxicity
  • Accepted for publication March 23, 2020.
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1 Jan 2021
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Improving Hydroxychloroquine Dosing and Toxicity Screening at a Tertiary Care Ambulatory Center: A Quality Improvement Initiative
Sahil Koppikar, Stephanie Gottheil, Chandra Farrer, Natasha Gakhal
The Journal of Rheumatology Jan 2021, 48 (1) 138-144; DOI: 10.3899/jrheum.191265

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Improving Hydroxychloroquine Dosing and Toxicity Screening at a Tertiary Care Ambulatory Center: A Quality Improvement Initiative
Sahil Koppikar, Stephanie Gottheil, Chandra Farrer, Natasha Gakhal
The Journal of Rheumatology Jan 2021, 48 (1) 138-144; DOI: 10.3899/jrheum.191265
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Keywords

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
HYDROXYCHLOROQUINE
QUALITY IMPROVEMENT
QUALITY OF CARE
RETINAL TOXICITY

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Keywords

  • disease-modifying antirheumatic drugs
  • hydroxychloroquine
  • quality improvement
  • quality of care
  • retinal toxicity

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