RT Journal Article
SR Electronic
T1 Improving rates of ferrous sulfate prescription for suspected iron deficiency anaemia in infants
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 588
OP 597
DO 10.1136/bmjqs-2018-009098
VO 28
IS 7
A1 Corinna J Rea
A1 Clement Bottino
A1 Jenny Chan Yuen
A1 Kathleen Conroy
A1 Joanne Cox
A1 Alexandra Epee-Bounya
A1 Radhika Kamalia
A1 Patricia Meleedy-Rey
A1 Kalpana Pethe
A1 Ronald Samuels
A1 Pamela Schubert
A1 Amy J Starmer
YR 2019
UL http://qualitysafety.bmj.com/content/28/7/588.abstract
AB Background Iron deficiency anaemia (IDA) in infancy is prevalent and associated with impaired neurodevelopment; however, studies suggest that treatment and follow-up rates are poor.Objectives To improve the rate of ferrous sulfate prescription for suspected IDA among infants aged 8–13 months to 75% or greater within 24 months.Methods We implemented a multidisciplinary process improvement effort aimed at standardising treatment for suspected IDA at two academic paediatric primary care clinics. We developed a clinical pathway with screening and treatment recommendations, followed by multiple plan-do-study-act cycles including provider education, targeted reminders when ferrous sulfate was not prescribed and development of standardised procedures for responding to abnormal lab values. We tracked prescription and screening rates using statistical process control charts. In post hoc analyses, we examined rates of haemoglobin (Hgb) recheck and normalisation for the preintervention versus postintervention groups.Results The prescription rate for suspected IDA increased from 41% to 78% following implementation of the intervention. Common reasons for treatment failure included prescription of a multivitamin instead of ferrous sulfate, and Hgb not flagged as low by the electronic medical record. Screening rates remained stable at 89%. Forty-one per cent of patients with anaemia in the preintervention group had their Hgb rechecked within 6 months, compared with 56% in the postintervention group (p<0.001). Furthermore, 30% of patients with anaemia in the postintervention group had normalised their Hgb by 6 months, compared with 20% in the preintervention group (p<0.05).Conclusions A multipronged interdisciplinary quality improvement intervention enabled: (1) development of standardised practices for treating suspected IDA among infants aged 8–13 months, (2) improvement of prescription rates and (3) maintenance of high screening rates. Rates of Hgb recheck and normalisation also increased in the intervention period.​