Improving vitamin D testing and supplementation in children with newly diagnosed cancer: A quality improvement initiative at Rady Children's Hospital San Diego. Issue 11 (19th July 2021)

• Record Type: Journal Article
• Authors: Shliakhtsitsava, Ksenya; Fisher, Erin Stucky; Trovillion, Erin M.; Bush, Kelly; Kuo, Dennis John; Newfield, Ron S.; Thornburg, Courtney D.; Roberts, William; Aristizabal, Paula
• Is Part Of: Pediatric blood & cancer. Volume 68:Issue 11(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-07-19
• Subjects: clinical guidelines -- pediatric cancer -- quality improvement -- vitamin D deficiency -- vitamin D supplementation; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.29217
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: 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.