Making physicians aware of their track record assessing vitamin D deficiency and adding computerized order sets to check vitamin D levels and initiate vitamin D supplementation led to "significant improvement" in assessment and treatment of vitamin D deficiency in elderly patients with hip fracture at a North Carolina hospital, according to a study published online in the Journal of Hospital Medicine.
After these interventions, the percentage of patients screened for vitamin D deficiency improved from 37.2% to 93.5% (P less than .001), and the percentage of deficient or insufficient patients discharged on the recommended vitamin D dose improved from 40.9% to 68% (P = .008), Dr. John R. Stephens of the University of North Carolina Hospitals and his colleagues reported (J. Hosp. Med. 2014 Sept. 5 [doi:10.1002/jhm.2255]).
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A new study shows that computerized physician order entry is key to increasing identification of vitamin D deficiency in patients.
The study authors reviewed the literature on the prevalence of vitamin D deficiency in elderly patients and used Endocrine Society guidelines "to define vitamin D deficiency, insufficiency, and recommended treatment dosing for each condition." They presented this information along with a review of data from their hospitalist group practice at a staff meeting.
They also revised the computerized physician order entry (CPOE) set for patients with hip fractures to include two new orders: an automatic order for 25-OH vitamin D level to be drawn the morning after admission and an order for initiation of 1,000 IU daily of vitamin D at admission.
They compared records of 196 patients (mean age 80), with hip fracture treated in the 28 months before these interventions and 107 similar patients treated in the 12 months following the interventions.
Three-quarters of the patients were female and at least 81% of the patients in both the intervention and preintervention groups were white in the single-center study.
"Our study demonstrates a systematic method groups may use to adopt and reliably implement practice guidelines," the authors wrote.
"With safeguards in the electronic system to flag duplicate medications, low toxicity of standard doses of vitamin D, and minimal economic harm with duplicate laboratory therapy in the context of a hospitalization for hip fracture," the researchers wrote, any possible risks "are outweighed by the benefits of screening."
They reported no conflicts of interest.