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.