Over the past few years the number of children identified with vitamin D insufficiency/deficiency across the UK has increased. The Department of Health has recently reiterated the guidance for practitioners regarding at risk groups requiring surveillance and treatment recommendations. An audit in 2011 demonstrated that 30% of the children presenting to the paediatric orthopaedic service with musculoskeletal symptoms had vitamin D insufficiency or deficiency.
At the time management of these children was found to be inconsistent between practitioners, with children randomly being referred to the paediatric endocrine service, followed up in orthopaedic clinic or discharged to GP for management.
Information given to parents by the orthopaedic service was also variable and 88% of parents were given no advice by their GP or hospital doctor on how to improve their childs vitamin D status.
The increasing number of referrals to the paediatric endocrine service were not manageable and were increasing the waiting times for all new appointments. Following discussion with the paediatric orthopaedic team it was agreed that the patient pathway for these patients was changed. Since January 2012 children with symptomatic vitamin D deficiency referred to the paediatric endocrine service are given an appointment with the clinical nurse specialist (CNS).
A standard operational procedure for clinic appointments was agreed to inform the structure and standards for the service. The CNS has undertaken further study and supervised practice to gain the necessary skills and expertise to manage this cohort of children. Standard guidelines for the management of vitamin D deficiency are followed and information provided to families in a way they can understand that promotes concordance with the suggested treatment. Once care is complete the patient is discharged to the care of the general practitioner with advice on maintaining optimum vitamin D levels in the future.
Challenges in establishing this service, benefits to the families and outcomes will be discussed.
13 Nov 2013
British Society for Paediatric Endocrinology and Diabetes