Physicians call for multifaceted fix to errant Vitamin D test orders

Physicians are frequently ordering the wrong test for vitamin D levels, and two advocates are calling for closer observation and better IT utilization to solve the problem.

An article in the January issue of Clinical Laboratory News highlighted news that 66 percent of 1,25 dihydroxyvitamin D tests were order in error—the physicians ordering meant to request a 25-OH vitamin D test. The two yield different results and are used in different settings.

Jane Dickerson, PhD, and Michael Astion, MD, the authors, attributed the mistakes to limited physician training in specialty areas and difficulty with computerized physician order entries, as well as many reference laboratory options and confusing test nomenclature.

"When the wrong test is ordered or the result is unacknowledged, patient harm is possible from delayed diagnosis and treatment, need for sample recollection and false reassurances from a normal test result," Dr. Dickerson and Dr. Astion wrote.

The authors said some of the responsibility should fall on an IT solution, such as clearer codes and less difficult CPOEs, but it comes down to the individual institution's needs and what solution will work best. They described a number of tools, ranging from "gentle" to "strong." Gentle tools included posting guidelines on requisitions and computerized reminders, and strong tools included utilization report cards and peer or leadership review, among others.

 

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