Intravenous Iron Prescribing Appropriateness Through Adherence to a Provincial Order Set for Inpatients: A...

Area of Science:

• Hematology
• Pharmacoeconomics
• Health Services Research

Background:

• Iron deficiency anemia (IDA) is a prevalent condition often managed with oral iron.
• Intravenous (IV) iron is reserved for cases unresponsive or intolerant to oral therapy, carrying higher costs.
• Formulary restrictions and order sets are used to control inappropriate IV iron use.

Purpose of the Study:

• To evaluate the appropriateness of IV iron prescribing by assessing adherence to provincial inpatient order set criteria.
• To compare adherence rates before and after the implementation of an IV iron order set.
• To analyze the impact of order set use versus handwritten orders on adherence.

Main Methods:

• Retrospective chart review of adult inpatients prescribed IV iron.
• Exclusion criteria included specific patient populations and short site data.
• Adherence was measured against criteria including hemoglobin levels, evidence of iron deficiency/blood loss, and justification for IV over oral iron.

Main Results:

• Two-thirds (64%) of patients met the order set criteria, with no significant change post-implementation (62% vs. 67%).
• Order set use significantly increased adherence (71%) compared to handwritten orders (58%).
• Common reasons for non-adherence included unavailable iron studies (53%) and unclear indication (44%), contributing to significant costs.

Conclusions:

• The IV iron order set alone did not statistically improve adherence to prescribing criteria.
• Non-adherence suggests patients may not have IDA or could be candidates for oral iron, increasing risks and costs.
• Mandatory order set use, education, and system supports may enhance adherence and optimize resource stewardship.