A quality improvement project to address the challenges surrounding zoledronic acid use in children.

TitleA quality improvement project to address the challenges surrounding zoledronic acid use in children.
Publication TypeJournal Article
Year of Publication2021
AuthorsWeber DR, Diaz MCristina G, Louis S, Rackovsky N, Rahmani R, Stauber SD
JournalJ Bone Miner Metab
Date Published2021 Apr 07
ISSN1435-5604
Abstract

INTRODUCTION: Zoledronic acid (ZA) is an intravenous bisphosphonate used to treat pediatric osteoporosis. Adverse events including hypocalcemia and acute phase reaction (APR) are common following first-infusion. The purpose of this report is to describe implementation of a ZA clinical practice guideline and the subsequent process changes to improve adherence to aspects of the protocol related to safety and efficacy.

METHODS: Quality assurance was evaluated by chart review over a 5-year period to compare the prevalence of hypocalcemia and APR to published data. A quality improvement (QI) initiative consisting of process changes including the addition of an endocrine RN to coordinate infusions and a shift to patient/family self-scheduling of infusions was conducted. The effect of the interventions on safety (completion of pre- and post-infusion bloodwork) and efficacy (receipt of all prescribed infusions) outcomes was evaluated.

RESULTS: Seventy-two patients received 244 infusions over the period. The frequency of hypocalcemia (22%) and APR (31%) was consistent with prior reports. 99% of patients received pre-infusion bloodwork, 78% received post-first-infusion bloodwork, and 47% received all prescribed infusions. QI initiatives increased the percentage of patients receiving post-first-infusion bloodwork from 67 to 79% and those receiving all infusions from 62 to 74%, but fell short of the goal of 90%.

CONCLUSIONS: The implementation of a standardized protocol for ZA use in children was successful in confirming patient eligibility with pre-infusion bloodwork but failed to ensure that patients obtained post-first-infusion bloodwork and received all prescribed infusions. Further efforts to systematize the management of children on ZA are needed.

DOI10.1007/s00774-021-01214-5
Alternate JournalJ Bone Miner Metab
PubMed ID33825940
Grant ListDK114477 / DK / NIDDK NIH HHS / United States