P3A096: Improving Vitamin D Supplementation in Newborns - Parent Education

Purpose/Objectives: Improve vitamin D supplementation for all newborns at our institution through parent education, physician reminders, and EMR changes in the newborn nursery and outpatient clinics.

Design/Methods: The preliminary step was a presentation given to residents regarding the physiologic importance of vitamin D supplementation and instructions for documentation and prescription of vitamin D. The changes were implemented in our institution’s newborn nursery and associated outpatient clinic.

Vitamin D was prescribed to all newborns discharged from the newborn nursery. Education about vitamin D became a formal part of the anticipatory guidance given to all new parents prior to discharge. Additionally, educational pamphlets about vitamin D were given to parents prior to discharge from the newborn nursery. Residents would then follow up on vitamin D compliance during subsequent 2-week and 8-week well child checks (WCC’s).

Residents were also instructed to include a pre-made phrase regarding vitamin D prescription and compliance in their EMR documentation. Residents were reminded about the phrase in weekly emails and via physical signs placed on computers in resident work areas. Eventually, our group created preset templates automatically embedded into our institution’s nursery discharge summary and clinic’s WCC note, including whether the patient was taking vitamin D supplementation and if vitamin D was prescribed at that visit.

Data was gathered by residents and medical students performing chart review of inpatient and outpatient records. Rates of prescriptions and compliance were recorded at newborn nursery discharge, 2-week WCC, and 8-week WCC.

Results: The following were calculated using newborn nursery and outpatient clinic EMR data 1 month before interventions and a 2 month period after interventions:
Before Intervention:
0% Prescribed Vit D Prior to discharge
0% Parents provided education
0% Receiving Vit D at 2 weeks WCC
0% Receiving Vit D at 8 weeks WCC

After Intervention:
100% Prescribed Vit D Prior to discharge
100% Parents provided education
14.2% Receiving Vit D at 2 weeks WCC
50.8% Receiving Vit D at 8 weeks WCC

Conclusion/Discussion: Providing inpatient and outpatient education to parents, changing EMR templates that ensured physicians prescribe and give instructions regarding vitamin D, and maintaining follow-up resulted in an increase in vitamin D supplementation. Creating a system that provides thorough education, follow up, and access is effective in increasing vitamin D supplementation and is a valuable contribution to routine newborn care. Next steps of this project include ongoing education to families and residents about vitamin D supplementation. We believe the model of implementing built-in reminders into an EMR can be used to ensure other standards of care are never missed during well child checks.