Vitamin D Protocol in a MS Clinic

Abstract

Vitamin D deficiency is a global health issue affecting more than half of society. Despite the existence of laboratory screening test and effective supplementation treatment, many vitamin D deficiencies go undetected and untreated. Consequences of undetected and untreated vitamin D deficiencies in Multiple Sclerosis patients can have detrimental lifetime effects. The purpose of this project was to create and implement a vitamin D protocol for increased screening and reduction of undetected and untreated deficiencies.

Education was provided to MS clinic providers regarding current evidence-based guidelines for vitamin D deficiency screening and testing. A vitamin D protocol was developed upon provider consensus of the vitamin D deficiency value definition and subsequent recommended supplementation dosing. Providers were prompted by chart alerts for patients who met criteria for routine vitamin D screening and supplementation for further test ordering or follow up. Through weekly chart audits, individual provider’s compliance to vitamin D ordering and vitamin D supplementation were tracked and reviewed monthly with the provider. Data was collected on the number of patients who met criteria for vitamin D testing per the protocol were compared with the number of patients whom vitamin D testing was ordered for. Of the 726 multiple sclerosis patients seen in the MS clinic during project implementation, 151 (20.8%) vitamin D tests were ordered for completion. This was an improvement by 2% compared to pre-implementation. Of the 151 patients, 82 (54%) vitamin D deficiencies were identified and 62 (76%) vitamin D supplement prescriptions written.

Developing a protocol for routine vitamin D screening and supplementation resulted in increased screening and supplementation of vitamin D deficiencies. Improved screening contributes to preventative healthcare and may lead to lower cost of healthcare. This project established standardized care for the practice, which is known to improve patient outcomes and reduce costs. This project translated the evidence on vitamin D and MS to help develop a unified, cost effective, and efficient approach to screening and treatment.