Abstract
Introduction: Vitamin D deficiency remains an important condition affecting our elderly population, with particular relevance to bone health, frailty syndromes and falls risks. We aimed to improve prescribing practices for deficient patients through the implementation of a prescribing tool and order set on our electronic system.
Methods: We retrospectively analysed data from patients admitted to two of our wards in July (pre-introduction of the order set) and November 2021 (post-introduction) respectively, paying particular attention to whether their vitamin D levels were measured as an inpatient, and then focusing on whether replacement was prescribed as an inpatient, on discharge and in the community, from their Greater Manchester GP Care Record.
Results: After review of a total of 266 patient records, following implementation of the prescribing guideline and order set, improvement was seen in prescribing practices in those identified as having low vitamin D on admission. 96% of deficient patients had a form of vitamin D replacement prescribed as an inpatient (compared with 84.4% pre-implementation), and 100% of patients had a form of vitamin D prescribed on discharge from hospital (compared with 90.7%). Despite seeing an improvement in identification of vitamin D deficient patients, a significant proportion of patients did not have their vitamin D level measured on admission.
Conclusion(s): Despite improvement seen in the initial identification of vitamin D deficiency and consistency of prescribing practices, we are failing to measure vitamin D levels on admission in a significant number of patients. Ways in which we can further develop this project include aiming to raise awareness of the importance of measuring vitamin D levels locally, and promoting continued use of the order set and frailty blood set amongst our junior doctors.