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. 2022 Dec 16;14(24):5360.
doi: 10.3390/nu14245360.

Vitamin D and Calcium Supplementation in Nursing Homes-A Quality Improvement Study

Charlotte Mortensen  1 , Inge Tetens  2 , Michael Kristensen  1 , Anne Marie Beck  3
Affiliations

Vitamin D and Calcium Supplementation in Nursing Homes-A Quality Improvement Study

Charlotte Mortensen et al. Nutrients. .

Abstract

Even though dietary supplements with vitamin D and calcium are recommended to nursing home residents, we recently reported a low adherence to this recommendation. The objective of this 20-week quality improvement study was to use the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles to improve adherence in Danish nursing homes. We included two nursing homes with 109 residents at baseline. An information sheet including the rationale for the recommendation was developed for the nurses to urge residents to take the supplements and seek approval by the general practitioner afterwards (PDSA cycle 1). Moreover, it was included in admission meetings with new residents to address supplementation (PDSA cycle 2). A nurse reviewed patient records for number of residents prescribed adequate doses of vitamin D (≥20 µg) and calcium (≥800 mg) before, during and after the intervention. At baseline, 32% (n = 35) of the residents had adequate doses of vitamin D and calcium. After implementation of the information sheet and adjustment to admission meetings, this increased to 65% (n = 71) at endpoint (p < 0.001). In conclusion, in this quality improvement study, we improved the number of prescriptions of adequate doses of vitamin D and calcium over 20 weeks using the Model for Improvement and PDSA experiments.

Keywords: Model for Improvement; adherence; calcium; nursing homes; supplements; vitamin D.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The Model for Improvement. Visual overview of the three initial steps followed by the PDSA cycle. * Input to step three from driver diagram (see Supplementary Figure S1). Abbreviations: GPs; General practitioner, HCPs; Health care professionals. Figure inspired by [25].
Figure 2
Figure 2
Illustration of the four phases Plan-Do-Study-Act of the PDSA cycle 1 in the project.
Figure 3
Figure 3
Development of adherence to the recommendation of vitamin D and calcium supplementation (≥20 µg vitamin D and ≥800 mg calcium) at two Danish nursing homes during the 20-week intervention period. “Fact sheet” refers to the information sheet used by the nurses to urge residents to have the supplements, and “first meeting” refers to the adjustment of admission meetings to include supplementation as a topic. Abbreviations: NH; Nursing home, PDSA; Plan-Do-Study-Act.
See this image and copyright information in PMC

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