Page 34 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
OP-20

Improving Utilisation of Parenteral Iron Therapy for Treatment of Iron Deficiency
Anaemia (IDA) in Medical Wards of Hospital Kuala Lumpur

Gan SS , Sharifah Suryani SRS , Yong ASW , Tan MMY , Chang CE , Lee HP 1
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1 Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur
2 General Medicine Department, Hospital Kuala Lumpur, Kuala Lumpur
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Blood transfusion has been used routinely for the treatment of IDA. However, there is an urgency to conserve
blood due to a marked decline in blood donation rate during the COVID-19 pandemic. Parenteral iron is
proven to be an efficacious alternative in treating IDA. A verification study showed only 9.3% of IDA patients
received parenteral iron.

KEY MEASURES FOR IMPROVEMENT:
The key indicator for improvement was measured using the percentage of IDA patients who received parenteral
iron. The standard is 40% based on haematologist consensus and practice in tertiary hospitals abroad.

PROCESS OF GATHERING INFORMATION:
A quality improvement study was conducted using convenience sampling in five medical wards from September
2020 until July 2022 in two consecutive phases. All IDA patients with traceable records were included, with
a total of 182 subjects. A survey was conducted among healthcare providers (HCP) to identify contributing
factors to the underutilisation.

ANALYSIS AND INTERPRETATION:
The pre-remedial study revealed only 9.3% of IDA patients received parenteral iron. Main contributing factors
include lack of confidence in using parenteral iron (52.8%), cost concerns (20.2%), lack of trained staff for
monitoring (15.7%) and no protocol to guide its use (15.7%).

STRATEGIES FOR CHANGE:
Parenteral Iron Infusion Protocol (PREFER) was developed. Several continuous medical and nursing education
sessions were conducted for training and to introduce PREFER. More strategies were building a PREFER
website with the feature of a smart dose calculator, poster displays in wards and adding a newer formulation of
parenteral iron to the hospital formulary.

EFFECT OF CHANGE:
The percentage increased from 9.3% to 20.6% in cycle 1, then improved to 33.3% in cycle 2. Achievable
benefit not achieved improved from 30.7% to 20.6% and finally to 6.7%. We have successfully conserved 100
pints of blood and saved RM7580.00 per month by utilising parenteral iron therapy.

THE NEXT STEP:
We plan to expand the study to other disciplines and publish PREFER at the state and national levels.

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