Improving Vitamin D testing and supplementation in children with
newly-diagnosed cancer: A Quality Improvement Initiative at Rady
Children’s Hospital San Diego
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.