Ensuring vitamin D supplementation in nursing home patients--a quality improvement project

J Nutr Gerontol Geriatr. 2012;31(2):158-71. doi: 10.1080/21551197.2012.678240.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dietary Supplements*
  • Female
  • Follow-Up Studies
  • Geriatric Nursing / methods*
  • Homes for the Aged*
  • Humans
  • Male
  • Middle Aged
  • North Carolina
  • Nursing Homes*
  • Quality Improvement*
  • Vitamin D / administration & dosage*
  • Vitamin D / therapeutic use
  • Vitamin D Deficiency / diet therapy
  • Vitamin D Deficiency / prevention & control

Substances

  • Vitamin D