Evaluation and adoption of Osteoporosis Prevention Clinical Practice Guidelines (CPGs) use within the inpatient program at Holland Bloorview Kids Rehabilitation Hospital
Women and Children
Two CPGs have been created to optimize bone health in high risk pediatric populations, particularly those with cerebral palsy (CP) or long-term use of glucocorticoids. At baseline only 23% of patients met the CPGs at the time of discharge, which was significantly below the target compliance rate of 80%. However, there was inadequate information at admission and discharge to determine compliance with the CPG in 75% of the charts reviewed. Quality improvement (QI) interventions will include an education session for front line clinicians focused on optimization of calcium, vitamin D, weight bearing exercises and safe handling practices as part of an osteoporosis prevention strategy. Compulsory data fields will be added to the electronic medical record (EMR) to capture adequacy of the total daily intake of calcium and vitamin D at admission and discharge. A second retrospective chart review will evaluate the effectiveness of the QI interventions. If successful, these strategies could be extended to other populations within our organization (e.g. respite clients) and shared widely with other inpatient rehabilitation hospitals that care for clients at high risk for osteoporosis.
OBJECTIVE: To determine the percentage of inpatient clients at risk for osteoporosis who were compliant with the Clinical Practice guidelines (CPGs) at admission and at discharge, with the goal of optimizing bone health.
METHOD: A retrospective chart review was conducted to identify the percentage of new inpatient program admissions at risk of osteoporosis from January 1 to June 30, 2015. The retrospective baseline data collected on study subjects at admission and at discharge included weight bearing status, dietary , medication and medical history. Compliance with the CPGs was defined as meeting the daily recommended amount of calcium and vitamin D and engaging in weight-bearing activities as tolerated.
RESULTS: At baseline 38% of new Inpatient Program admissions (n = 48) were at risk of osteoporosis based on CPG criteria. The percentage of individuals who were in complicance with the CPG at admission and at discharge were 15% and 23% (n=7 and 11), respectively. All patients were engaged in weight-bearing activities during their Inpatient admission. The compliance with daily recommended intake at admission and at discharge for calcium were 15% vs. 23%, and for vitamin D 33% vs. 46%, respectively. However, in 75% of charts (n=36) there was inadequate information at admission and discharge to determine compliance with the CPG.
CONCLUSION: Based on baseline data collection we are not meeting the CPG recommendations at our target of 80% at the time of discharge. Many factors are likely contributing, including incomplete dietary record and inadequate education for front line clinicians regarding the importance of CPG recommendations for bone health. Next steps include implementation of an education program and changes to the EMR, with evaluation of its effectivness on improving CPG compliance.