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Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West. PowerPoint PPT Presentation


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Sophie Jagatia Deborah Lee Charlotte Haynes. Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West. Part 1: The Provider Services Audit Sept – Nov 2010. This work was undertaken in the Clinical Effectiveness Unit , Stockport NHS FT

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Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West.

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Sophie Jagatia

Deborah Lee

Charlotte Haynes

Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West.

Part 1: The Provider Services Audit

Sept – Nov 2010

This work was undertaken in the Clinical Effectiveness Unit, Stockport NHS FT

Funded by the Greater Manchester Supra District Audit Committee


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Aims

Provider services audit was developed to gain an insight into:

  • Current local vitamin D policies in place

  • Current practice of midwives and health visitors regarding discussing/supplementing vitamin D

  • Training needs of midwives and health visitors


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Acute Trusts:

Central Manchester University Hospitals NHS FT

Liverpool Women’s NHS FT

Pennine Acute Hospitals

Stockport NHS FT

Wirral University Teaching Hospital NHS FT

East Lancashire Hospitals NHS FT (staff survey only)

Royal Bolton Hospitals NHS FT (staff survey only)

Primary Care Trusts:

Liverpool Community Health NHS Trust

NHS East Lancashire

NHS Ashton, Leigh and Wigan

NHS Heywood, Middleton and Rochdale

NHS Manchester

NHS Wirral

Methods: Participants


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Methods: Data collection

Provider Services Trust Proforma

  • One proforma sent to lead contacts at each Trust

  • Establish current vitamin D practice and policy in place (e.g. local guidelines, training programmes, in-house leaflet, Healthy Start)

    Staff Survey

  • Online/paper based survey sent to all midwives and health visitors at participating Trusts

  • Establish current knowledge, practice and training needs relating to vitamin D supplementation with pre/postnatal women.


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Findings:Provider Services Trust Proforma

  • Only 1 Acute Trust and 1 PCT reported a vitamin D policy in place

  • 1 Acute Trust and 3 PCTs reported having vitamin D representative/coordinator/team in place.

  • 3 Acute Trusts and 3 PCTs reported having incorporated vitamin D into training policies.

  • Majority of Trusts reported providing midwives/health visitors with some information on vitamin D


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Findings: Staff survey

Response rate:

  • Total of 178 health visitors and 206 midwives across the 6 PCTs and 8 Acute Trusts participated in the survey.

  • Gives an overall response rate of

    • 44% health visitors

    • 14% midwives


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Findings: Staff Survey

Knowledge:

  • 1/3 of MWs and HVs identified correct RDA of vitamin D

  • Approx 75% of MW’s and HV’s aware of vitamin D’s role in the absorption of calcium, but only 18% for phosphorous

  • 60% HVs and 46% MWs able to list 3 or more vitamin D rich food sources – oily fish most common

  • 22% HVs and 12% MWs incorrectly identified green vegetables as source

  • >60% of MWs and HVs able to identify 3 or more risk factors/symptoms of vitamin D deficiency


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Findings: Staff Survey

Most commonly identified risk factors/symptoms of vitamin D deficiency


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Findings: Staff Survey

Vitamin D training and practice:

  • 47% of HVs and 22% of MWs reported discussing vitamin D with ‘all’ or ‘most’ clients.

  • A lack of knowledge was the most reported reason for not discussing vitamin D with clients.

  • 42% of HVs and 29% of MWs reported being ‘very confident’ or ‘confident’ in discussing vitamin D

  • 24% of HVs and 11% of MWs reported having received training in vitamin D

  • Approx 80% of HVs and MWs thought it would be ‘useful’ or ‘very useful’ to have further training in vitamin D.


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Findings: Staff Survey

Reasons for not discussing vitamin D amongst midwives and health visitors who reported not discussing vitamin D with ‘all’ clients


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Findings: Staff Survey

Healthy Start

  • 76% of HVs and 37% of MWs reported discussing Healthy Start with ‘all’ or ‘most’ clients

  • 33% of midwives reported not discussing Healthy Start with any clients.

  • Most frequently reported reason for not discussing HS:

    • HVs: clients not eligible to receive Healthy Start (67%)

    • MWs: not seen as part of their role (37%)

  • 57% of HVs and 21% of midwives reported having a list of Healthy Start distributors to refer clients to.

  • 81% of HVs and 39% of midwives reported feeling confident directing clients to a Healthy Start distribution point.


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Findings: Staff Survey

Reasons for not discussing Healthy Start amongst midwives and health visitors who reported not discussing Healthy Start with ‘all’ clients.


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Summary of Findings

  • Policies, practice and personnel are lacking amongst majority of Trusts

  • There is a lack of knowledge amongst both MWs and HVs about the importance and facts surrounding vitamin D.

  • Confidence in discussing vitamin D is low

  • Few MWs and HVs reported having been trained in vitamin D supplementation

  • However, where policies were in place, MWs and HVs appeared more knowledgeable and confident, and practice was markedly different to those Trusts yet to tackle the issue.

  • Limitations:

    • Small sample of MWs took part in survey

    • Lack of response to online survey lead to paper copy having to be distributed

    • Some Trusts may have implemented policies since this work was carried out.


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Recommendations

  • 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 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.


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