Quality Improvement

Impact of a Replacement Algorithm for Vitamin D Deficiency in Adult Hematopoietic Stem Cell Transplant Patients

Sheila A. Kenny,(1) MSN, RN, ANP-BC, Karen Collum,(1) DNP, RN, OCN®, Catherine A. Featherstone,(1) MSN, RN, FNP-BC, Azeez Farooki,(1,2) MD, and Ann Jakubowski,(1,2) PhD, MD

(1) Memorial Sloan Kettering Cancer Center, New York, New York; (2) Weill Cornell Medical College, Cornell University, and Memorial Sloan Kettering Cancer Center, New York, New York

Authors’ disclosures of conflicts of interest are found at the end of this article.

Sheila A. Kenny, MSN, RN, ANP-BC, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail: kennys@mskcc.org


J Adv Pract Oncol 2019;10(2):109–118 | https://doi.org/10.6004/jadpro.2019.10.2.2 | © 2019 Harborside™


  

ABSTRACT

Adults undergoing hematopoietic stem cell transplant (HSCT) are at risk for vitamin D deficiency. After HSCT, exposure to sunlight is restricted, and patients may experience poor nutrition and malabsorption from HSCT-related side effects. Vitamin D affects bone health and immunologic processes. The aim of this project is to establish a process for monitoring and treating vitamin D deficiency and to evaluate if therapeutic vitamin D levels are attainable posttransplant using an HSCT vitamin D replacement algorithm. A multidisciplinary group led by advanced practice providers established a workflow for monitoring and supplementing vitamin D and created an HSCT vitamin D replacement guideline. The medical records of 144 adult HSCT patients were reviewed, and the records of another 72 patients were reviewed a year later. Historical baseline data before the intervention found that 81% of patients were vitamin D deficient and 30% received supplementation. Postintervention and at 1-year follow-up, 76% and 65% of patients were vitamin D deficient before transplant and 97.1% and 100%, respectively, received supplementation for vitamin D deficiency. Post-HSCT compliance with monitoring demonstrated that approximately 91% of patients had a vitamin D level checked within 6 months of transplant. After implementation of the algorithm, there was a statistically significant difference (p < .001) between deficient vitamin D levels pretransplant (72.9%) and posttransplant (26.4%). Results demonstrate sustained compliance over a 2-year period with monitoring and supplementation of vitamin D pre- and peritransplant. Aggressive vitamin D repletion posttransplant decreased the incidence of vitamin D deficiency in HSCT patients. Further study is needed to investigate the long-term effects of vitamin D repletion on posttransplant complications.




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