Date of Graduation


Document Type



Prolia, Denosumab, protocol, side effects, guidelines, adherence

Degree Name

Doctor of Nursing Practice (DNP)

Degree Level



Kelly Young

Committee Member

Allison Scott

Second Committee Member

Desiree Douglas


Denosumab, or Prolia, is a medication given to increase bone mineral density (BMD) and prevent fracture risk in patients with osteoporosis. Guidelines for monitoring of side effects, data on long-term effects, and appropriate precautions are still being researched and developed. Healthcare teams are often unaware of preventative care measures to guide informed clinical decision making and patient care management. The recognized gap in care also reduces the standardization of health care delivery in clinics administering Prolia; this gap can lead to errors and miscommunication between patients and healthcare teams an increased risk for side effects. The aim of this translation of evidence into practice project was to improve risk-reduction and reporting, patient and staff knowledge and satisfaction, and lab placement and serum calcium monitoring adherence through the creation and implementation of a standardized protocol for Prolia administration. The target population for this project was patients receiving Prolia at an outpatient infusion clinic in a suburban area of South Carolina (SC). The protocol standardized patient and staff education, clinical decision-making, and preventative care measures for patients receiving Prolia. A quasi-experimental research design was used to analyze the impacts of the Prolia protocol. Independent sample t-test results included significantly improved serum calcium monitoring adherence, serum calcium order placement adherence, and prevalence of side effects reported to the healthcare team in the experimental group when compared to the control group. Additionally, there was a positive patient response in a follow-up survey to assess patient satisfaction and increased knowledge. The development and implementation of the evidence-based protocol for Prolia administration was successful in demonstrating improvement in patient outcomes, standardization of care, and promoted safe healthcare delivery.

Available for download on Thursday, April 27, 2023