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

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 describe implementation a ZA clinical practice guideline the subsequent process changes improve adherence aspects protocol related safety efficacy. Quality assurance was evaluated by chart review over 5-year period compare prevalence APR published data. A quality improvement (QI) initiative consisting addition endocrine RN coordinate infusions shift patient/family self-scheduling conducted. effect interventions on (completion pre- post-infusion bloodwork) efficacy (receipt all prescribed infusions) outcomes evaluated. Seventy-two patients received 244 period. frequency (22%) (31%) consistent with prior reports. 99% pre-infusion bloodwork, 78% post-first-infusion 47% infusions. QI initiatives increased percentage receiving bloodwork from 67 79% those 62 74%, but fell short goal 90%. standardized for use in children successful confirming patient eligibility failed ensure that obtained Further efforts systematize management needed.