Announcement: New Vitamin D (25(OH)D) Ordering Criteria and R...


Announcement: New Vitamin D (25(OH)D) Ordering Criteria and Requisition

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Announcement: New Vitamin D (25(OH)D) Ordering Criteria and Requisition

Team: ChoosingWiselyContent

Date: This is not a timed event.

Description


 

Date Effective: February 1, 2016

Date Issued: January 21, 2016

 

Clinical Practice Change for Ordering Practitioners:

  • 25-hydroxy vitamin D (25(OH)D) testing will only be performed for patients meeting the new medically indicated criteria, as outlined on the new requisition form. Please see new requisition attached as Appendix A, which identifies medically indicated criteria.
  • The new requisition form, available in your Electronic Medical Record (QHR, Jonoke and Med-Access) and on the Diagnostic Services Manitoba (DSM) Laboratory Information Manual (https://apps.sbgh.mb.ca/labmanual/test/loadDocumentPdf?documentId=1301), must be used for 25(OH)D;  if the requisition is not available in your EMR, please contact your vendor for assistance; DSM is making every effort to remove or amend all requisitions with a 25(OH)D ordering cue; while some requisitions may still be available, they will not be honoured after May 2, 2016.
  • The new 25(OH)D  requisition requires the signature of the ordering practitioner and will not be processed when the signature is missing.

 

Rationale for Change:

  • Clinical evidence shows that screening for vitamin D deficiency in healthy individuals is generally not necessary as it does not provide patient benefit.

 

References/Resources

  • Hanley, D. A., Cranney, A., Jones, G., Whiting, S. J., Leslie, W. D. 2010. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary), CMAJ, 182 (12), 1315-1319.
  • Hanley, D. A., Cranney, A., Jones, G., Whiting, S. J., Leslie, W. D., Cole, D. E. C., Atkinson, S. A., Josse, R. G., Feldman, S., Kline, G. A., Rosen, C. 2010. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada, CMAJ, 182 (12), E610-E618.
  • Souberbielle, J-C., Courbebaisse, M., Cormier, C., Pierrot-Deseilligny, C., Viard, J-P., Jean, G., Cavalier, E. 2012. When should we measure Vitamin D concentration in clinical practice? Scandinavian Journal Clinical & Laboratory Investigation. 75 (243), 129-135.
  • Institute of Medicine 2010 Report www.nap.edu/read/13050/chapter/1
  • Health Canada www.hc-sc.gc.ca/fn-an/nutrition/vitamin/vita-d-eng.php

 

Patient Impact:

  • To facilitate a smooth rollout of the new requisition and lessen impact to both your practice and patient care, there will be a transition period during which the laboratory will accommodate requests for 25(OH)D, that are not received on the new requisition, while continuing to prioritize medically indicated tests:
  • Phase I – February 1-May 1: All 25(OH)D tests will be processed on the new and old requisitions, as per current practice; ordering practitioners will be alerted to the error if an old requisition was used.
  • Phase II – May 2-July 3: Incorrect or incomplete requisitions will result in the sample being collected but held for processing until the correct/completed requisition is received by the DSM laboratory; the sample will be held for one month and then discarded; patients who do not meet the new medical indications will not be eligible for 25(OH)D testing; ordering practitioners will be alerted to the error.
  • Phase III – Full Implementation Effective July 4: Patient samples will not be drawn when presenting with the incorrect or incomplete requisition; ordering practitioners will be alerted to the error.                           
  • Effective July 4, 2016 DSM labs will not collect blood from patients producing the incorrect or incomplete requisition; follow up to the physician will be done by either the patient or the lab.
  • Effective July 4, 2016 samples collected in non-DSM facilities and arriving to the DSM lab with the wrong or incomplete requisition will not be processed; the DSM lab will follow up with the physician and physicians will be responsible for follow up with their patients.
  • Medically indicated 25(OH)D tests will continue to be prioritized.

 

System Improvements:

  • A reduction in unnecessary 25(OH)D testing will improve service delivery for medically indicated/priority tests.

 

Background Information

  • This Clinical Practice Change is an initiative of Choosing Wisely Manitoba. This initiative aims to reduce unnecessary Vitamin D testing by as much as 50%.

 

Clinical Practice Change issued by: Choosing Wisely Manitoba – Dr. Michael Moffatt, Senior Advisor with the Centre for Healthcare Innovation; Dr. Laurel Thorlacius, Medical Director, Clinical Biochemistry and Genetics, Diagnostic Services Manitoba; Dr. Celia Rodd, Pediatric Endocrinologist; Albert Mota, Project Manager, Centre for Healthcare Innovation

Distribution: This Clinical Practice Change is directed to all ordering professionals in Manitoba

 

Contact Information:

Questions? Please contact the DSM phone center 204-787-1534, and they will address your concerns or redirect them as required.

 

More information:

  • All 25(OH)D testing for the province is performed at the Diagnostic Services Manitoba Laboratory at the Health Sciences Centre
  • Manitoba’s new 25(OH)D ordering guidelines are aligned with those of other provinces who have implemented evidence based criteria to increase the appropriate use of this test; Ontario restricted testing in  2010 and in Alberta, as part of the Choosing Wisely initiative, testing was restricted in 2015.

 

Patient information tear-off sheets are available by request – 5.5” x 8.5” pads of 100. Please contact Krista Hand – khand@dsmanitoba.ca or 926.8005

 

Choosing Wisely Manitoba and its initiatives to improve patient care are supported by the Manitoba College of Family Physicians, the College of Physicians and Surgeons of Manitoba and Doctors Manitoba.

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