Vitamin D4 by dxpq97


									This regional audit is funded by the
Supra-district Clinical Audit Committee
•little known about the current local Vitamin D practice and policies across
the North West

•Very little exposure to ultraviolet light and reliance on already existing
vitamin D stores and additional dietary intake.

•1.6% of the children examined had rickets of the 4000, 6–12 month old
ethnic children resident in the city of Manchester in 1991.

•The cost of treating a child with rickets is estimated to be £5000 per case. In
1991 this would have cost £300, 000 to treat each case

•Across Greater Manchester claims for free women’s vitamins is dramatically low
0.0% - 16%

•Total cost of prescribed vitamin D treatment including both ergocalciferol and
colecalciferol across GM is £4,053,310.68 (June 2010 –May 2011)

• Aim to improve use of guidelines and therefore patient care.
            6 Primary Care Trusts

          Liverpool Community Health NHS Trust
          NHS East Lancashire                                                                              Standard
          NHS Blackburn and Darwen
          NHS Ashton, Leigh and Wigan               Training                                               100%
          NHS Heywood, Middleton and Rochdale            Vitamin D training given to midwifes and
          NHS Manchester                                  health visitors so that
          NHS Wirral                                      pregnant/breastfeeding women are advised
                                                           about vitamin D supplement uptake upon
             10 Acute Trusts                               booking
          Central Manchester University Hospitals        Health professionals to be provided with          100%
           NHS FT                                         information on vitamin D availability, benefits
          Liverpool Women’s NHS FT                       and implications
          Pennine Acute Hospitals
                                                     Assessment and Delivery of Vitamin D                   100%
          Stockport NHS FT
                                                         All maternity patients undergo an assessment
          Wirral University Teaching Hospital NHS
           FT                                             of risk factors for vitamin D deficiency upon
          East Lancashire Hospitals NHS FT (staff        confirmation of pregnancy.
           survey only)
          Royal Bolton Hospitals NHS FT (staff          Pregnant women to be verbally advised on the       100%
           survey only)                                   importance of vitamin D at first contact
          North General Manchester NHS Trust
          Royal Oldham Hospital Trust                    10 micrograms of vitamin D prescribed to all      100%
          Fairfield General Hospital Trust               pregnant women regardless of vitamin D
* Trusts who have implemented/ implementing new guidance/policy/tool
or protocol since the audit to increase vitamin D awareness
                        Completed by                Developed to gain an insight
Provider services   Senior staff to complete on   Local  vitamin D policies and guidance
      Audit         behalf of the Trust           Current practice of midwives and health
                                                  visitors regarding discussing/supplementing
                                                  vitamin D
  Staff Survey      Completed by midwives and     Training   needs of midwives and health
     Audit          health visitors               visitors

Case Note Audit     100 case notes audited        Evaluate   practice
                    between Oct 2009 – March      Establish if midwives and health visitors
                    2010                          mention Vitamin D in midwifery or health
                                                  visiting notes
                      Written                                    Vitamin D information                   Vitamin D
                                                   Vitamin D                             Vitamin D In-
       Trust          vitamin D   Vitamin D team
                                                                 given to midwives/
                                                                                         house leaflet   Training
                      policy                                     health visitors                         available

               CMFT        P            O               O                 P                     O             O
               LWH          O           P               O                  O                    O             O
               PAT          O           O               O                 P                     O             P
               SFT          O           O               O                 P                     O             O
               WUTH         O           O               O                 P                     O             P
               WWL          O           O               O                 P                     O             P
          NHS ALW           O           O               O                  O                    O             P
           NHS EL          P            P               P                 P                     P             P
          NHS B&D          P            P               P                 P                     P             P
          NHS HMR          P            O               O                 P                     O             O
           NHS LIV          O           O               P                 P                     O             O
          NHS MAN           O           P               P                  O                    O             O
          NHS WIR           O           O               O                  O                    O             O
•Lack of knowledge about
vitamin D was the most
reported reason for not
discussing vitamin D

•More midwives than health
visitors selected that it was not
part of their role as a reason
for not discussing vitamin D
with clients
       Nice Guidelines;
       “All women should be informed at booking about the importance for their own and their
       baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst

  Health visiting case note results                                               Midwifery case note results
100%                                                                        100%

90%                                                                         90%

80%                                                                         80%

70%                                                                         70%
60%                                                                         60%

                                                                                            258                                                      FALSE
50%                                                                         50%

40%                                                                         40%

30%                                                                         30%

20%                                                                         20%
10%                                                                         10%

0%                                                                           0%
        Literature given to client   vitamin D discussed with the client?            Vitamin D discussed with client   Literature given to clients
Recommendations have been derived from discussions, visits
   and feedback from midwifery and health visiting leads

   All Trusts should start the process of developing a vitamin D
    policy relating to pre/postnatal women

   All MWs and HVs need to be educated through appropriate
    training session regarding the importance and practices for
    supplementation for pre/postnatal women

   All women should receive a discussion and literature to
    reinforce the information given by the health professional.

   All Trusts should ensure they have info and up-to-date
    distribution lists for Healthy Start vitamins

   Those Trusts with a vitamin D policy in place/training packages
    should share their documentation/resources with other Trusts.
Since the audit recommendations, 4 Trusts visited and are now

      Policy / guidelines
      Leaflets for distribution
      Dedicated team to increase awareness
      Training (web and class room based)
      CQUIN to promote the uptake of HS vitamins
      Approaching GP’s
    Focusing on changing practice               Focusing on improving care

   Developed a Vitamin D project team             keep to date with changes and ensure local
                                                    projects are completed.
   Additional designated health centres
    distributing HS vitamins                       Increases access points for women

   Developed CQUIN to promote the uptake          Monitoring will increase awareness and pinpoint low
    of HS vitamins for mothers and children         distribution areas.

   Currently developing policy's in               To ensure the correct advice is given and
    community and hospital setting                  followed

   Developing a vitamin D leaflet for public      To reinforce information discussed at the
    use                                             appointment, so that an informed decision to
                                                    supplement can be made
   Distributing information and promotional
    materials for Gp’s                             Gp involvement is crucial to increase awareness
                                                    and treating/testing women.
   Changed documentation to record
    vitamin D discussions                          Monitoring will increase awareness and highlight if
                                                    advice is not been given, it will also prompt to
                                                    advise about vitamin D
   Introducing and developing training
                                                   Training will improve knowledge, understanding
                                                    and confidence in giving vitamin D related advice
   Audit those who have introduced new guidance or a vitamin D
    policy to their care pathway

   To assess improvement in promoting the awareness of
    vitamin D the participating trusts

   To assess whether the standards set in 2009 audit have been

   To include trusts not engaged in previous audit

   To inform commissioners of community and acute maternity
Don’t forget to supplement with Vitamin D!

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