PDSA #2: Implementation phase (February 1, 2016 to June 30, 2016).
We conducted an educational intervention focused on Vitamin D deficiency and insufficiency testing and supplementation for oncology providers (physicians and advance practice providers), nurses, case managers, and pharmacists via direct one-on-one in-person communication, structured in-person lectures and secure e-mails. The decision-making tree was distributed as hardcopy and was made widely available and posted in the inpatient unit, outpatient clinic working space, and the secure shared oncology folder online. EMR triggers and Vitamin D automated testing options were incorporated. A Vitamin D laboratory order was added into the pre-existing oncology admission order set as well as in Beacon chemotherapy treatment plans, an Epic® oncology module for physicians and pharmacists to create treatment and supportive care plans based on standardized protocols that also allows for easy modification. A BPA alert was created that triggered if the patient had a chemotherapy treatment plan in place but did not have recent Vitamin D testing, or if Vitamin D testing was done but the patient was not taking Vitamin D.
In order to assess end-user value, we created a 6-question secure online de-identified survey utilizing the SurveyMonkey®platform. The survey was administered to oncology providers after interventions were executed. The survey included the following questions: 1) What are the barriers preventing Vitamin D initial testing at the time of cancer diagnosis? (Free text response); 2) Do you use the Vitamin D supplementation decision-making tree? (Likert scale); 3) Do you find the Vitamin D supplementation decision-making tree helpful? (Likert scale); 4) What are the barriers preventing repeat Vitamin D testing at 6-8 weeks after Vitamin D supplementation initiation? (Free text response); 5) Do you use the Vitamin D BPA? (Likert scale); 6) Do you find Vitamin D BPA reminders helpful? (Likert scale). For questions 2, 3, 5 and 6, a traditional Likert scale with 1-5 ratings was used to assess value/usefulness, with 1 = none, 2 = little, 3 = some, 4 = moderately high, and 5 = high. The percentage of results for “moderately high“ or “high” for each question were reported.