Doctor of Nursing Practice Program

• Committee Chair Name & Credentials:
  Sharon M. Karp, PhD, APRN, CPNP-PC
• Committee Member Name & Credentials:
  Colleen R. Moss, DNP, APRN, NNP-BC

DNP Project Abstract

Improved Adherence to Vitamin D Guidelines for Exclusively and Partially Breastfed Newborns

Purpose
The American Academy of Pediatrics (AAP) recommends vitamin D supplementation for all infants. Adherence to AAP guidelines remains low despite evidence supporting the effectiveness of supplementation. The aim of this quality improvement project was to improve provider adherence to AAP vitamin D guidelines in a newborn nursery.

Methods
This project used a Plan-Do-Study-Act (PDSA) cycle to develop and implement a standardized discharge order set for prescribing vitamin D supplementation for breastfed newborns. Provider adherence to guideline recommendations following order set implementation was assessed via chart review and descriptive statistics were used to assess the effectiveness of interventions.    

Results
There were 883 patient encounters from January 17, through February 28, 2022. Adherence to guideline recommendations was 41.6% (n = 121) for exclusively breastfed newborns and 16.9% (n = 71) for partially breastfed newborns. Overall provider adherence was 30.5% (n = 75) at 2 weeks and 27.0% (n = 192) at six weeks.

Implications for Practice
Findings were consistent with previous reports, noting improvements in prescribing rates after implementing a standardized discharge order set. Barriers to implementation included a lack of provider awareness or agreement with recommendations. Although goal adherence was not achieved, electronic order sets can be effective in improving provider adherence to evidence-based practice guidelines.