TY - JOUR
T1 - Improving vitamin D testing and supplementation in children with newly diagnosed cancer
T2 - A quality improvement initiative at Rady Children's Hospital San Diego
AU - Shliakhtsitsava, Ksenya
AU - Fisher, Erin Stucky
AU - Trovillion, Erin M.
AU - Bush, Kelly
AU - Kuo, Dennis John
AU - Newfield, Ron S.
AU - Thornburg, Courtney D.
AU - Roberts, William
AU - Aristizabal, Paula
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/11
Y1 - 2021/11
N2 - Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for vitamin D deficiency and insufficiency. At our institution, we identified high variability in vitamin D testing and supplementation in this population. Of those tested, 65% were vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve vitamin D testing and supplementation among children aged 2–18 years with newly diagnosed cancer to ≥80% over 6 months. Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post supplementation. Interventions included an institutional vitamin D guideline, clinical decision-making tree for vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options. Results: Baseline: N = 26 patients, four (15%) had baseline vitamin D testing; two (8%) received appropriate supplementation. Postintervention: N = 33 patients; 32 (97%) had baseline vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6–8 weeks post supplementation). Change was sustained over 24 months. Conclusions: We achieved and sustained our aim for vitamin D testing and supplementation in children with newly diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with vitamin D supplementation and impact on patients’ vitamin D levels.
AB - Background: Vitamin D deficiency and insufficiency have been associated with poorer health outcomes. Children with cancer are at high risk for vitamin D deficiency and insufficiency. At our institution, we identified high variability in vitamin D testing and supplementation in this population. Of those tested, 65% were vitamin D deficient/insufficient. We conducted a quality improvement (QI) initiative with aim to improve vitamin D testing and supplementation among children aged 2–18 years with newly diagnosed cancer to ≥80% over 6 months. Methods: An inter-professional team reviewed baseline data, then developed and implemented interventions using Plan-Do-Study-Act (PDSA) cycles. Barriers were identified using QI tools, including lack of automated triggers for testing and inconsistent supplementation criteria and follow-up testing post supplementation. Interventions included an institutional vitamin D guideline, clinical decision-making tree for vitamin D deficiency, insufficiency and sufficiency, electronic medical record triggers, and automated testing options. Results: Baseline: N = 26 patients, four (15%) had baseline vitamin D testing; two (8%) received appropriate supplementation. Postintervention: N = 33 patients; 32 (97%) had baseline vitamin D testing; 33 (100%) received appropriate supplementation and completed follow-up testing timely (6–8 weeks post supplementation). Change was sustained over 24 months. Conclusions: We achieved and sustained our aim for vitamin D testing and supplementation in children with newly diagnosed cancer through inter-professional collaboration of hematology/oncology, endocrinology, hospital medicine, pharmacy, nursing, and information technology. Future PDSA cycles will address patient compliance with vitamin D supplementation and impact on patients’ vitamin D levels.
KW - clinical guidelines
KW - pediatric cancer
KW - quality improvement
KW - vitamin D deficiency
KW - vitamin D supplementation
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U2 - 10.1002/pbc.29217
DO - 10.1002/pbc.29217
M3 - Article
C2 - 34286891
AN - SCOPUS:85110883244
SN - 1545-5009
VL - 68
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
IS - 11
M1 - e29217
ER -