Improved vitamin D supplementation in hospitalized breastfed infants through electronic order modification and targeted provider education.
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.
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and caroline.watnick@gmail.com.
Caroline S
CS
Watnick
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and Departments of Pediatrics, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Mary Ann and J. Milburn Smith Child Health Research Program, Ann and Robert H. Lurie Children's Hospital of Chicago Research Center, Chicago, Illinois; and.
Helen J
HJ
Binns
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and Departments of Pediatrics, and.
Robert S
RS
Greenberg
D001942:Breast Feeding / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods; D019587:Dietary Supplements; D055695:Electronic Prescribing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D007223:Infant; D008297:Male; D050316:Medical Order Entry Systems; D011314:Preventive Health Services / Q000379:methods; D014807:Vitamin D / Q000627:therapeutic use*; D014808:Vitamin D Deficiency / Q000517:prevention & control*
D014807:Vitamin D
AAP guidelines; breastfed infants; electronic medical record; order set modification; vitamin D; vitamin D deficiency; vitamin D supplementation