DMARD Patient Safety Dashboard App
Last updated
Share PrintThe goal of the DMARD Patient Safety Dashboard App is to improve safe prescribing of DMARD medications. The DMARD Latent Infections Dashboard focuses on screening for latent infections (tuberculosis (TB), hepatitis B virus (HBV), and hepatitis C virus (HCV)) prior to starting new immunosuppressants, and the Hydroxychloroquine Dashboard focuses on weight-based dosing of hydroxychloroquine.
Origin:
October 2020, San Francisco VA Medical Center
Adoptions:
17 in-progress
Partners:
Quality Enhancement Research Initiative
Recent Updates
Overview
The problem
Hydroxychloroquine (HCQ) is a conventional DMARD commonly used for patients with rheumatoid arthritis or systemic lupus erythematous. Although long-term use of HCQ can cause retinal toxicity, this risk can be reduced if high doses of the drug are avoided. Studies suggest that many patients are receiving higher than recommended doses of this drug. See more
Files
- Study: Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety Hydroxychloroquine dosing in immune-mediated diseases: implications for patient safety
- Study: RISE registry reveals potential gaps in medication safety for new users of biologics and targeted synthetic DMARDs RISE registry reveals potential gaps in medication safety for new users of biologics and targeted synthetic DMARDs
The solution
Links
- Introduction video reviewing the aspects of each dashboard on the DMARD Patient Safety App. Introduction to the DMARD Patient Safety App
The results
Files
- Study: Time series analysis examining the effectiveness of the Hydroxychloroquine Patient Safety Dashboard among VA pilot sites. HCQ Dashboard time series analysis manuscript
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
![](https://prod-dm.s3.us-gov-west-1.amazonaws.com/practice_multimedia/attachments/000/000/226/thumb/ITSA_pilot_image.png?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=ASIAR2ERFC2NHDGR45RE%2F20240831%2Fus-gov-west-1%2Fs3%2Faws4_request&X-Amz-Date=20240831T230450Z&X-Amz-Expires=2700&X-Amz-Security-Token=FwoDYXdzEHoaDDKECtsYTbrDDDK68SLkBMIThmvG59S47ri%2BJYYrIBkquCJpAWF3M3DrhVu6F4jQjmPuTGKpKcV4Ovd2UafJ3UT2q8DFdLH2D9baM%2BEGRsSg2rFf8OWsC66MC5s4jIfG7YmYyqMR1G1FOKTYtYCBDtOUzLYV9wG8wzsHDF0cxJg42O26HXvfjqAXPELrHrE8lMh05qklBqurg5600dGzijKwYn3xy0Hmk2H%2FWIGkp8drAx36uQqBRjxi7Ogtg1zyT%2B01dsfqHD74LFCaBU18qw3UxDBXCFB6UiyapVazqpMpxSKCr8M59%2BoT3BxwZOcgUlj5rGaa2RUMb8KsG9MZSd8z3Tbjy1XRDwrXhBZ7YqebG8WZ937ZZrAkQxW71v0YoQlumKSUVrsOyx64zx8xYKeWg5N4NNJo4t%2B6df4oWIdmjxBsBKub3mwGP6v09zkXxsm07OdbhXNxL0%2F%2BIxRubVUODFtCRVgDVYkZKnUqYBqpbX%2F70%2B%2FktQc6ddzbYARcWFUArBqHVxrwzcPa12xovxRLidB0uqOnBfm8ysOSlBNBrTlf9NgK%2BNwMEurhiliBu9BocdZJ93%2B1EFFgZLCvfJ9XnZVxFnbQB456xxDKN2%2F%2BZBJAdAUNuc2zSuGLYDX6dEzD9IfRjbyBfB8zTZ5%2FMoErJ9oTGWVJjdyZF9OrgXdOr6temoeDrX3F4%2FvWgNSOcPeIA0Yk8amt4dBig7OcGAEthwZXMfMxCiexBlJ40nSNeMmHzMf0AhjAkAKSXQdaApucB5EcvzUx2KBwYyCWFvKGWd0xBIdzzEzHgGYuIwzjVh%2B07m9FTmxu4PRrHNs0UF%2BcFiih4s22BjJBcnRvlC7mh%2F9bmm0iUg47nIHUYXjjFT1Njx7m8GQyNXgztXy27iBrZB%2FFv3E83AN8p4bhgh6%2FnJFAN%2F%2FZQtcWv0E%3D&X-Amz-SignedHeaders=host&X-Amz-Signature=c426c4981d0d51f2e24d38945f52b3824f7a9d520afc1484f39fe69ea72ae65b)
Above:
Results from a pragmatic trial of the VA DMARD Dashboard App: Interrupted time series analysis shows that the proportion of patients receiving high doses of hydroxychloroquine decreased over time among pilot facilities compared to controls.
Implementation
Timeline
-
Spring 2022
The DMARD Patient Safety Dashboard App is available to all VA personnel with access to CPRS.
Departments
- Dermatology
- Gastroenterology
- Hematology/Oncology
- Pharmacy
- Rheumatology
Core Resources
Resource type | Resource description |
---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
|
Files
- Hydroxychloroquine Patient Safety Dashboard Clinic Workflow Swimlane Diagram Example of dashboard clinic workflow
Links
- DMARD Patient Safety App Landing Page DMARD Patient Safety App
- This toolkit is to support the DMARD Patient Safety App's dashboards by providing presentations, slide decks, email templates, and other resources to aid efforts to increase pre-screenings and safe prescribing for Veteran patients on high-risk immunotherapies. DMARD Patient Safety Toolkit
Risks and mitigations
Risk | Mitigation |
---|---|
Disclaimers for the DMARD Latent Infections dashboard |
TB testing information comes from lab tests, clinical note titles, or health factors, but not clinical not narratives; therefore, TB tests for some patients may not be captured in the dashboard. Providers that are *Unknown at this time* may be non-VA providers within the community. All medications are captured through "active" orders in CPRS with the exception of injections: injectable medications are captured within 1 year of their order date. |
Disclaimers for Hydroxychloroquine Dashboard | For orders with complex medication instructions (sigs) or those that do not match the quantity dispensed, the calculated dose in mg/kg/day may be inaccurate. |
About
Origin story
Original team
Gabriela Schmajuk
Project Primary Investigator, Rheumatologist
Anna Montgomery
Program Manager, Data Analyst
Gary Tarasovsky
Data Manager, Data Analyst
Comment
Comments and replies are disabled for retired innovations and non-VA users.