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

David R Weber1,2, Maria Cristina Gil Diaz3, Silvia Louis3

  • 1Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 590, Rochester, NY, USA. weberd@email.chop.edu.

Journal of Bone and Mineral Metabolism
|April 7, 2021
PubMed

Insights

Implementing a zoledronic acid (ZA) clinical guideline in pediatric osteoporosis improved pre-infusion checks but not post-infusion monitoring or complete treatment adherence. Further systematization is needed for ZA patient management.

Area of Science:

  • Pediatric Endocrinology
  • Pharmacology
  • Quality Improvement in Healthcare

Background:

  • Zoledronic acid (ZA) is an intravenous bisphosphonate for pediatric osteoporosis.
  • Hypocalcemia and acute phase reaction (APR) are common adverse events after initial ZA infusions.
  • Standardized protocols are crucial for managing ZA safety and efficacy in children.

Purpose of the Study:

  • To describe the implementation of a zoledronic acid (ZA) clinical practice guideline in pediatric osteoporosis.
  • To evaluate process changes aimed at improving adherence to safety and efficacy protocols.
  • To assess the impact of quality improvement initiatives on patient outcomes.

Main Methods:

  • A 5-year chart review assessed hypocalcemia and APR prevalence.
  • A quality improvement initiative involved adding an endocrine RN and self-scheduling infusions.
  • Outcomes measured included pre- and post-infusion bloodwork completion and receipt of all prescribed infusions.

Main Results:

  • 72 patients received 244 ZA infusions; hypocalcemia (22%) and APR (31%) rates were consistent with prior data.
  • Pre-infusion bloodwork completion was high (99%).
  • Post-first-infusion bloodwork adherence improved from 67% to 79%, and complete infusion adherence from 62% to 74%, but both fell short of the 90% goal.

Conclusions:

  • Standardized ZA protocols confirm patient eligibility via pre-infusion checks.
  • Adherence to post-infusion bloodwork and completion of all prescribed ZA infusions remains suboptimal.
  • Systematic management strategies are required to optimize ZA therapy in pediatric patients.
Abstract

Keywords:
BisphosphonatesOsteoporosisQuality assessmentQuality improvementZoledronic acid

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