Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West. Part 1: The Provider Services Audit.

Measuring and Improving Vitamin D Promotion and Prescribing to Prenatal and Postnatal Women within the North West.Part 1: The Provider Services AuditSept – Nov 2010

This work was undertaken in the Clinical Effectiveness Unit, Stockport NHS FTFunded by the Greater Manchester Supra District Audit Committee

Sophie Jagatia

Deborah Lee

Charlotte Haynes

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

Methods: Participants

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: 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.

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

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

Findings: Staff SurveyKnowledge: 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

Findings: Staff SurveyMost commonly identified risk factors/symptoms of vitamin D deficiency

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.

Findings: Staff SurveyReasons for not discussing vitamin D amongst midwives and health visitors who reported not discussing vitamin D with ‘all’ clients

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.

Findings: Staff SurveyReasons for not discussing Healthy Start amongst midwives and health visitors who reported not discussing Healthy Start with ‘all’ clients.

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.

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.