Download 2355 Switching from a low dose Intravenous iron prepartion to a

2355
SWITCHING FROM A LOW DOSE INTRAVENOUS IRON PREPARTION TO A
HIGH DOSE PREPARATION: WHAT IS THE IMPACT ON THE SERVICE?
Johnson, J¹, Dring, B¹, O’Donnell, D¹, Taylor, K¹
¹Renal and Transplant Department, Nottingham University Hospitals NHS Trust
BACKGROUND: Intravenous (IV) iron is a common treatment for iron deficiency in the renal
population. Oral iron is not sufficient for many patients resulting in the need for iron to be
administered into a vein. New guidance recommending resuscitation equipment is available for
all IV iron administration means most IV iron is being given in a hospital setting (MHRA).
For patients not receiving haemodialysis,
(HD) this means attending an outpatient department at the hospital. Hospital outpatients are
becoming increasingly busy therefore we looked at how we could release space within out
department to allow room for other services, whilst also reducing the number of appointments to
the patient.
SERVICE REVIEW: The renal unit have historically used a low dose, high frequency IV
iron on all their patients. In retrospective audit of 1100 doses it was identified most patients
(50%) received 600mg of iron sucrose. This meant the patient had to visit the unit 3 times. 17%
of the doses were 1gram, 200mg and 400mg of iron sucrose. 83% of patients returned to
hospital for more than one appointment. This did not seem appropriate for patients, nor good
utilisation of staff time. Therefore in September 2012 it was agreed to switch to a high dose
preparation.
A case was put together to switch all non-haemodialysis patients to a high dose iv iron to see
what impact this had on clinic follow ups, patient results, and the effects this may have on ESA
doses.
FINANCIAL IMPACT: Changing from a low to high dose preparation did have a financial
impact, as the cost of a high dose drug was significantly higher than the low dose drug. Also it
meant the unit would be losing out on hospital attendance, however it was envisaged the clinic
space and staff time could be used more effectively.
RESULTS: 835 iron infusions were given in 2013-2014. 767 high dose irons and 68, 200mg
doses of iron sucrose were administered. Iron sucrose was given because of patient choice or
because a smaller amount of iron was needed. 73% of the iron was 500mg with only 19%
requiring a full gram. The percent requiring 1gram is very close to those requiring 1 gram of
sucrose, but they received this in fewer visits. The number of patients requiring iron has not
reduced, however the number of appointments needed to correct their deficiency is considerably
less allowing us to promptly administer treatment to an increasing population and offer our
services out to other health care providers.
COMMENT: Switching from a low dose IV iron preparation to a high dose preparation has a
number of advantages to the patient and the service. Although there was a financial impact in
switching the drug and receiving less income for visits this has been balanced out by the
anaemia clinic space being used to provide IV iron to other specialities.