5PSQ-017 Implementation and monitoring of a protocol for the use of intravenous iron

Background The Pharmacy and Therapeutics Committee approved in May 2017 a protocol for the prescription of intravenous iron in order to achieve the correct use of it in the hospital, and the establishment of an iron sucrose complex as first choice in admitted patients. Purpose The objective of this study was to assess the degree of adaptation of the prescriptions to the protocol. Material and methods We conducted a retrospective observational study from May 2017 to July 2018. In order to assess the degree of adaptation of the prescriptions it was checked if the requests were received correctly completed for type of patient (inpatient or outpatient), medical service, diagnosis and cause and patient’s bodyweight, and if there were iron metabolism data (transferrin saturation, serum ferritin and iron) previous to the request.We also recorded the pharmaceutical product prescribed (ferric carboxymaltose or sucrose). Likewise, we reviewed if administered doses were correct, taking into account the theoretical deficiency calculated according to the Ganzoni formula. Dosage was considered correct if the difference between the administered dose and the theoretical deficiency did not exceed ±500 mg in ferric carboxymaltose and ±200 mg in sucrose. Results A total of 271 prescriptions were analysed (outpatients 51.3%). The internal medicine department was the main service prescriber (47.2%), followed by the gastroenterology department (21.8%). The principal medical diagnosis was anaemia. The cause was unknown in 35.5% of patients. Concerning the three main reasons for prescription, in descending order they were: need for fast iron replenishment (56.5%), inefficiency or intestinal malabsorption syndromes (14.7%) and intolerance to oral iron or impossibility to an oral regimen (11.4%) The reasons were unknown in 4.1%. Data of iron metabolism was not available in 34.7% of requests. Ferric carboxymaltose was the pharmaceutical product chosen in most of the patients (54.6%), of which 62% were outpatients. The total dose administered did not match the theoretical deficiency calculated in 41.3% of cases. Conclusion The lack of data in many orders received in the pharmacy department makes it difficult to verify the appropriateness of the prescription to the protocol in many cases. This highlights that protocolisation is a dynamic process which requires a continuous assessment to ensure its utility. Ferric carboxymaltose was used more frequently in iron replenishment in outpatients and iron sucrose in hospitalised patients. References and/or acknowledgements No conflict of interest.