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 old 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: Pre-intervention: N=26 patients, four (15%) had
baseline Vitamin D testing; two (8%) received appropriate
supplementation. Post-intervention: 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.