G16 Improving vitamin d supplementation in children with epilepsy prescribed anti-epileptic medication with the use of quality improvement methodology. (May 2019)

• Record Type: Journal Article
• Authors: Scott, M; Corrigan, N; Kerrigan, K
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A7
• Page End: A7
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.16
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: Evidence suggests that children treated with anti-epileptic drugs (AED's) are at an increased risk of vitamin D deficiency. This has been recognised by the RCPCH 'Guide for Vitamin D in Childhood'. Vitamin D deficiency is associated with loss of bone mineral density and an increased fracture risk. Recommendations have been made that children prescribed AED's should receive supplemental vitamin D. Our clinical experience suggested that this was not routinely being offered. We wanted to determine the number of these children receiving vitamin D and ultimately improve this figure with the overall aim of improving bone health. Methods: Interrogation of clinic databases and the regional electronic care record identified those patients attending epilepsy clinic's and concomitantly prescribed AED's/Vitamin D supplementation. Following a literature review, a guideline and algorithm for Vitamin D prescribing was created in conjunction with the hospital's pharmacy and medicines management team. This guideline was agreed by the trust and subsequently communicated to hospital and GP colleagues alongside informative teaching sessions. A patient/parent information leaflet was created and all those patients meeting the criteria were contacted and vitamin D prescription offered. Following this series of interventions, the electronic care records were interrogated to again look at vitamin D prescription in this cohort of patients. Run charts were used to capture results after each intervention. Results: Of the 261 patients attending the epilepsy clinic, 175 met the criteria for requiring vitamin D supplementation. Prior to intervention 12 (7%) were prescribed vitamin D. Following the first month of patient contact this improved to 90 (51%) and to 107 (61%) following the second month. Overall this has shown a 790% percentage improvement with ongoing reviews of the database planned. Conclusion: By improving vitamin D supplementation we are pro-actively improving the bone health of children receiving AED's. We feel this will have far reaching effects in terms of health benefits and also health economics. Engagement with our pharmacy, GP and specialist nurse colleagues have been fundamental to successfully implementing a robust method to ensure the appropriate children receive correct vitamin D supplementation.