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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 Criteria 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 “status”. * 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 into: 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 coordinator 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 Acute Trusts 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 PCTs 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 breastfeeding”. Health visiting case note results Midwifery case note results 100% 100% 90% 90% 108 80% 80% 196 70% 70% 189 60% 60% 258 FALSE 50% 50% TRUE 40% 40% 290 30% 30% 202 20% 20% 79 10% 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 implementing; 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 achieved To include trusts not engaged in previous audit To inform commissioners of community and acute maternity services Don’t forget to supplement with Vitamin D!
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