226 - Shedding Light on Sun Safety: A Quality Improvement Project

Publication Number: 226.6791

Danielle N. Bonser, Phoenix Children's Hospital, Phoenix, AZ, United States; Jacob C. Shalkevich, Phoenix Children’s Hospital, Phoenix, AZ, United States; Carley A. Cestary, Phoenix Children's Hospital, Scottsdale, AZ, United States; Austin Cooper, Phoenix Children's, Glendale, AZ, United States; Matthew J. DeVries, Phoenix Children's Hospital, Phoenix, AZ, United States; Robert T. Duncan, Phoenix Children's Hospital, Mesa, AZ, United States; Colton Merrill, Phoenix Children’s Hospital, Phoenix, AZ, United States; Priscilla R. Morelli, Phoenix Children's Hospital, Phoenix, AZ, United States; Destiny Newsome, Phoenix Children's Hospital, Phoenix, AZ, United States; Saurabh Patil, Phoenix Children's Hospital, Phoenix, AZ, United States; Ashnaa Rao, Phoenix Children's Hospital, Phoenixx, AZ, United States; David Robertson, Phoenix Children's Hospital, Phoenix, AZ, United States; Winter L. Tate, Phoenix Children's Hospital, Phoenix, AZ, United States; Taylor A. Zoellner, Phoenix Children’s Hospital, Scottsdale, AZ, United States; Joanna Kramer, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Sun exposure is the main environmental cause of skin cancer which is increasing in incidence. Children and adolescents likely receive three times as much UV exposure as adults annually. Limiting UV exposure and establishing sun safety practices in childhood is paramount to preventing skin cancer. Therefore, targeted, individualized conversations regarding establishing sun safety behaviors early in childhood is crucial.

Objective: We aim to increase anticipatory guidance on sun safety given to patients ages 12-months and above who present to the Phoenix Children’s Ambulatory Clinic for well visits from a baseline of 15% in June of 2023 to a goal of 50% of by June of 2025 and maintain improvement through June of 2026.

Design/Methods: Interventions included the creation of a smart phrase for use in end of visit summaries, a handout on sun safety written in patient-centered language, and reminders embedded into the EMR. Education was provided to residents on providing anticipatory guidance regarding sun safety during their ambulatory rotation. We also partnered with the Phoenix Children’s Injury Prevention Division to provide sunscreen to patients to encourage implementation of sun safety measures. Our outcome measures analyzed the number of patients over 12 months of age who received anticipatory guidance on sun safety as compared to the total number of patients presenting for well visits.

Results: Data from July 2022- June 2023 shows a baseline mean of 15% of patients receiving anticipatory guidance on sun safety at well visits. Our project was initiated in August 2023. Since implementation, we have demonstrated an increase from our baseline of 15% to a mean of 55% and has remained at or above our initial goal of 40% since March of 2024. Therefore, we adjusted our goal to 50% of visits; slightly lower than current performance due to anticipated seasonal variability in sun safety guidance given.

Conclusion(s): Our quality improvement project demonstrates a substantial increase in anticipatory guidance on sun safety given to patients over 12 months old at well visits from a baseline 15% to consistently greater than 55%. Strategies included resident education, sunscreen distribution, and EMR enhancements. We incorporated sun safety guidelines and markers into the EMR system to remind residents to discuss this topic, and sun safety products are now available to provide to families in clinic. Future directions of this study will evaluate a process measure of sunscreen distributed to families and a balancing measure ensuring sun safety is not discussed at the expense of other anticipatory guidance topics.

Rates of Sun Safety Anticipatory Guidance given at Well Child Checks
Control chart depicting baseline rates of sun safety anticipatory guidance given at well child appointments, with increase after project initiation in August 2023. Major interventions and goal denoted on graph.