Vitamin K policies and midwifery practice: questionnaire survey.
OBJECTIVE
To investigate policies on neonatal vitamin K and their implementation.


METHODS
Two phase postal survey.


METHODS
United Kingdom.


METHODS
A 10% random sample of midwives registered with the United Kingdom Central Council for nursing, midwifery, and health visiting. Of 3191 midwives in the sample, 2515 (79%) responded to phase one and 2294 (72%) completed questionnaires on their current jobs (November 1998 to May 1999). In phase two, 853 (62%) of 1383 eligible midwives gave details on 2179 of their earliest jobs (start dates before 1990).


RESULTS
All the midwives in clinical practice at the time of the survey (2271, 99%) reported that they were working in areas with official policies on neonatal vitamin K. Seven distinct policies were described: intramuscular vitamin K for all babies (1159, 51.0%); intramuscular vitamin K for babies at "high risk," oral for others (470, 20.7%); oral vitamin K for all babies (323, 14.2%); parental choice for all (124, 5.5%); parental choice for all except babies at high risk, (119, 5.2%); intramuscular vitamin K for babies at high risk only (33, 1.5%); oral vitamin K for babies at high risk only (17, 0.7%); and a disparate group of policies including intravenous vitamin K for some babies (26, 1.1%). Previous policies were (and some may still be) open to individual interpretation and were not always followed.


CONCLUSIONS
Hospital policy is not necessarily a good guide to individual practice. The primary purpose of clinical records is to document patient care, and recording practices reflect this. There is considerable variation in vitamin K policies and midwifery practice in the United Kingdom, and there is no clear consensus on which babies should receive vitamin K intramuscularly.
Ansell
P
P
Leukaemia Research Fund Centre, Institute of Epidemiology, University of Leeds, Leeds LS2 9LN. p.e.ansell@leeds.ac.uk
Roman
E
E
Fear
N T
NT
Renfrew
M J
MJ
D000284:Administration, Oral; D002985:Clinical Protocols; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D008499:Medical Records; D008880:Midwifery / Q000379:methods*; D018579:Patient Selection; D011181:Postnatal Care / Q000379:methods*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014812:Vitamin K / Q000008:administration & dosage* / Q000627:therapeutic use; D006475:Vitamin K Deficiency Bleeding / Q000517:prevention & control*
D014812:Vitamin K