title: Ensuring vitamin D supplementation in nursing home patients--a quality improvement project.
abstract: Randomized controlled trials have shown that adequate vitamin D supplementation in nursing home (NH) residents reduces the rates of falls and fractures. In our NH, review of medication administration records of all patients (n = 101) revealed that only 34.6% of the patients were currently prescribed adequate doses of vitamin D, revealing a need for intervention. We designed a Quality Improvement (QI) project with the objective of improving the vitamin D prescription rate in our NH. We used the Plan-Do-Study-Act (PDSA) approach to implement this QI project. Patients not currently prescribed an adequate dose of vitamin D were identified and started on a daily dose of 800 IU of vitamin D. Additionally, patients who were experiencing falls while on an adequate dose of vitamin D for 3 months were examined for the possibility of vitamin D deficiency and were started on 50,000 IU of vitamin D per week for 12 weeks if they were found to be vitamin D-deficient based on blood levels of 25-hydroxy-vitamin D below 30 ng/mL. We found that with several PDSA cycles over a period of 5 months, the prescription rate for vitamin D was increased to 86%, surpassing our initial goal of 80%. In conclusion, we found that a multidisciplinary QI program utilizing multiple PDSA cycles was effective in reaching target prescription rates for vitamin D supplementation in a population of NH patients.
authors.affiliation: Duke University Medical Center, Durham, North Carolina 27710, USA. mamata.yanamadala@dm.duke.edu
authors.forename: Mamata
authors.initials: M
authors.lastname: Yanamadala
authors.forename: Mitchell T
authors.initials: MT
authors.lastname: Heflin
authors.forename: Heidi K
authors.initials: HK
authors.lastname: White
authors.forename: Gwendolen T
authors.initials: GT
authors.lastname: Buhr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D005851:Geriatric Nursing / Q000379:methods*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D009735:Nursing Homes; D058996:Quality Improvement; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000178:diet therapy / Q000517:prevention & control
chemical_list: D014807:Vitamin D