Recent literature fails to demonstrate sufficient evidence to support a vitamin D protocol in residential care.

What’s happening?

The Student Practice Team would like to inform students and faculty instructors in residential care placements that the following Clinical Decision Support Tools (CDSTs) have been discontinued: 

CDST  Status  Effect date 
Vitamin D Protocol in Residential Care Facilities – Clinical Protocol, and Cholecaliferol (Vitamin D3) – Pre-Printed Order
DISCONTINUED  July 25, 2018 

Why is this important?

  • Recent literature fails to demonstrate sufficient evidence to support a vitamin D protocol in residential care.
  • Evidence for improvement of both musculoskeletal (fractures, falls) and non-skeletal (cancer, cardiovascular, gastrointestinal, infection, metabolic, mortality, neurological, respiratory, other) outcomes through vitamin D supplementation is weak, inconsistent, and uncertain.
  • Prescription of a medication of questionable benefit contributes to polypharmacy and does not support a palliative approach to care focused on enhancing quality of life.

How will this impact students and faculty instructors?

Students and faculty instructors who are completing student placements in Fraser Health must consult with their clinical areas to determine what practices must be followed to ensure that our residents continue to receive safe and quality care.

If appropriate, review residents’ medications to ensure alignment with goals of care and therapeutic evidence.

Use the Guiding Principles to de-prescribe and prescribe vitamin D:

  1. Person-Centered Care
    Prescription of Vitamin D must reflect person-centered care, shared decision-making, and the use of clinical judgement. This is achieved through careful discussion with the resident and/or their health care representative. Sharing up-to-date information helps guide evidence-based decision-making.
  2. Residential Care Population
    When deciding to prescribe Vitamin D the prescriber is asked to acknowledge the characteristics of the residential care population. The majority of residents suffer from advanced disease and frailty and will experience a very limited life expectancy (less than 24 months). A medication intended for preventive purposes, with uncertain therapeutic benefit, should not be prescribed.
  3. Palliative Approach to Care
    The palliative approach to care is a clinical quality priority in Fraser Health residential care and the focus is on ensuring care that enhanced quality of life. There is no evidence that vitamin D supplementation supports that goal.

Questions?

Please contact the Student Practice Team at student.placement@fraserhealth.ca


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