Munir Jawad, Wright Rebecca J, Carr David B
Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63108, USA.
J Am Med Dir Assoc. 2007 Mar;8(3 Suppl 2):e19-23. doi: 10.1016/j.jamda.2006.12.004.
The objectives of this study were to evaluate the impact of a quality improvement (QI) study on improving calcium and vitamin D supplementation in a long-term care setting.
Retrospective chart review.
An academic long-term care facility that specializes in dementia care in St Louis, MO.
Participants consisted of 83 long-term care residents.
The quality improvement team created an educational letter that was signed by the medical director and sent to the facilities' primary care physicians. This letter provided clinicians with the rationale and method to achieve adequate calcium supplementation, assess vitamin D status, and provide adequate vitamin D supplementation in our long-term care setting. Following the letter, the facility pharmacist reviewed the orders during monthly medication reviews and faxed requests to the primary care physicians for appropriate supplements or laboratory tests when necessary.
We reviewed the charts for the presence of calcium supplementation orders, vitamin D levels, and vitamin D supplementation before and after our QI intervention.
Of the 83 resident charts that were reviewed, only 37 (44.6%) had calcium supplementation, 19 (22.8%) had assessment of their vitamin D status, and 29 (34.9%) had ongoing vitamin D supplementation prior to implementation of the study. After the QI intervention, calcium supplementation was present in 66 residents (79.5%), vitamin D status had been assessed in 61 residents (73.4%), and vitamin D supplementation had been initiated in 65 residents (78.3%). These changes were statistically significant (P < .05).
A quality improvement project that used an educational letter from the medical director combined with a medication and laboratory review by the pharmacist was able to increase the number of residents in our long-term care setting with calcium supplementation, increase the number of residents who had vitamin D status assessed, identify many residents with low vitamin D levels, and increase supplementation of vitamin D when indicated.
本研究的目的是评估一项质量改进（QI）研究对改善长期护理机构中钙和维生素D补充情况的影响。
回顾性图表审查。
密苏里州圣路易斯市一家专门从事痴呆症护理的学术性长期护理机构。
参与者包括83名长期护理居民。
质量改进团队撰写了一封由医学主任签署的教育信，并发送给机构的初级保健医生。这封信向临床医生提供了在我们的长期护理机构中实现充足钙补充、评估维生素D状态以及提供充足维生素D补充的基本原理和方法。在发出这封信之后，机构药剂师在每月的药物审查期间查看医嘱，并在必要时向初级保健医生传真请求，以获取适当的补充剂或实验室检查。
我们审查了图表，以了解QI干预前后钙补充医嘱、维生素D水平和维生素D补充情况。
在审查的83份居民图表中，只有37份（44.6%）有钙补充，19份（22.8%）对其维生素D状态进行了评估，29份（34.9%）在研究实施前正在进行维生素D补充。QI干预后，66名居民（79.5%）有钙补充，61名居民（73.4%）的维生素D状态得到了评估，65名居民（78.3%）开始了维生素D补充。这些变化具有统计学意义（P < 0.05）。
一项质量改进项目，采用医学主任的教育信并结合药剂师的药物和实验室审查，能够增加我们长期护理机构中接受钙补充的居民数量，增加对维生素D状态进行评估的居民数量，识别出许多维生素D水平低的居民，并在有指征时增加维生素D补充。
