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Improved vitamin D supplementation in hospitalized breastfed infants through electronic order modification and
Caroline S Watnick1, Helen J Binns2, Robert S Greenberg3
1Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and caroline.watnick@gmail.com.
Insights
Provider education and electronic order set changes significantly boosted vitamin D supplementation for hospitalized breastfed infants. This intervention improved prescribing rates during and after hospital stays.
Area of Science:
- Pediatrics
- Nutritional Science
- Hospital Quality Improvement
Background:
- Vitamin D deficiency is a concern in infants, particularly those who are breastfed.
- Hospitalized infants may not consistently receive recommended vitamin D supplementation.
- Standardizing supplementation protocols can improve infant health outcomes.
Purpose of the Study:
- To assess the effectiveness of an intervention aimed at increasing vitamin D supplementation for hospitalized, breastfed infants.
- To evaluate the impact of provider education and electronic health record modifications on prescribing practices.
Main Methods:
- A two-part intervention was implemented: provider education on vitamin D guidelines and integration of an opt-in vitamin D order into electronic admission sets.
- Data from infants under one year old admitted to an urban tertiary care hospital were analyzed.
- Pre-intervention (6 months prior) and post-intervention (6 months after) prescribing rates were compared using statistical analyses, including logistic regression with adjustments for patient clustering.
Main Results:
- The study analyzed 471 admissions of breastfed infants (441 infants).
- In-hospital vitamin D prescribing increased significantly from 19.5% pre-intervention to 44.4% post-intervention (P<.001).
- Post-intervention, infants were more than twice as likely to receive vitamin D (aOR 2.3), with significant increases in discharge prescribing as well (9.0% vs 19.6%, P<.001).
Conclusions:
- A combined intervention of provider education and electronic order set optimization effectively increased vitamin D supplementation in hospitalized breastfed infants.
- These changes led to a significant improvement in both in-hospital and discharge vitamin D prescribing rates.
- The study highlights the success of system-level changes in promoting adherence to pediatric nutritional guidelines.
Objective:
To examine effectiveness of an intervention promoting vitamin D supplementation in hospitalized breastfed infants.
Methods:
Our urban tertiary care hospital instituted a 2-part intervention: brief education for providers on vitamin D guidelines and insertion of an opt-in order for vitamin D supplements into electronic admission order sets. Data downloads on admissions of patients aged <1 year were obtained. We excluded those not breastfed, with a dietary restriction, or admitted to intensive care. Intervention effects were compared from 6 months postintervention to the 6 same months 1 year earlier. We applied χ2 and logistic regression, including the patient as a random effect to adjust for repeated admissions.
Results:
Data on 471 exclusively or partially breastfed admissions (441 infants) were analyzed (221 preintervention, 250 postintervention). Admission characteristics did not differ by period: 55.0% boys; 40.6% Medicaid; 63.7% hospitalized ≤2 days; 72.0% on a general medical service; 16.6% received nutritionist consultation. In-hospital vitamin D prescribing rates significantly increased postintervention (19.5% vs 44.4%; P<.001). Postintervention admissions were more than twice as likely to receive vitamin D supplementation (adjusted odds ratio 2.3, 95% confidence interval 1.6-3.2). Other associated factors included vitamin D as a medication used before admission (adjusted odds ratio 14.3, 95% confidence interval 4.9-41.6), nutritionist consultation during admission, hospitalization≥3 days, and admission to a general medical service. Prescribing of vitamin D at discharge increased significantly (9.0% vs 19.6%; P<.001).
Conclusions:
Medical provider education and modification of electronic ordering templates significantly increased use of vitamin D supplementation in hospitalized breastfed infants.
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