Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e775-e781 (doi:10.1542/peds.2007-1898)
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ARTICLE

Dietary Supplements: Inpatient Policies in US Children's Hospitals

Paula Gardiner, MD, MPHa,b, Russell S. Phillips, MDa,c, Kathi J. Kemper, MD, MPHd, Anna Legedza, ScDa, Silas Henlon, BAe and Alan D. Woolf, MD, MPHf

a Osher Institute, Harvard Medical School, Boston, Massachusetts
c Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
d Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
f Children's Hospital, Boston, Massachusetts
b Department of Family Medicine, Boston Medical Center, Boston, Massachusetts
e Post-Baccalaureate Premedical Certificate Program, University of Massachusetts, Boston, Massachusetts

BACKGROUND. Variations in hospital policies and practices regarding the use of vitamins, minerals, herbs, and other dietary supplements could compromise patient safety and quality of care. We undertook this study to describe pediatric hospital policies regarding dietary supplements.

METHODS. We administered a cross-sectional survey of a sample of National Association of Children Hospitals and Related Institutions members. Pharmacy personnel were asked about the following: written policies addressing dietary supplements; how such policies are made; and responsibilities for storage, administration, documentation, and checking for potential interactions. We created a 10-point hospital policy and practices quality score to assess the quality of each policy.

RESULTS. Of the 186 eligible National Association of Children Hospitals and Related Institutions hospitals, 109 responded (59%). Forty-four percent reported having written policies on vitamins and minerals, herbs, and other dietary supplements. Few hospitals had herbs (2%) or other dietary supplements (38%) on formulary. However, most (81%) allowed patients to use their home supply of dietary supplements under defined circumstances, and 64% allowed staff to make recommendations about dietary supplement use. In 70% of hospitals, nurses stored and administered the home supply of dietary supplements. Less than half (46%) required documentation of a check for drug or dietary supplements interactions. One third (32%) had surgical preoperative recommendations regarding dietary supplements. Only 11% of 109 hospitals satisfied the 10 criteria necessary for a perfect hospital policy and practices quality score indicative of quality practices regarding patient use of dietary supplements.

CONCLUSION. Even among those hospitals that have written policies about dietary supplements, there is a wide range in policy quality, which may compromise the safety of patients.

Key Words: dietary supplements • pediatrics • hospitals • policy

Abbreviations: DS—dietary supplement • JCAHO—Joint Commission Accreditation of Healthcare Organizations • HPPQS—hospital policy and practices quality score • FDA—Food and Drug Administration

Accepted Aug 24, 2007.