描述并比较肠外铁剂订单集(DECODE IRON)实施前后与使用肠外铁剂相关的患者因素。

The Canadian journal of hospital pharmacy Pub Date : 2024-01-10 eCollection Date: 2024-01-01 DOI:10.4212/cjhp.3500
Cameron Black, Thomas Brownlee, Darren Pasay
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引用次数: 0

摘要

背景:在特定的临床情况下,静脉注射铁剂适用于缺铁性贫血的治疗;但对于大多数患者来说,口服铁剂是治疗的主要方法。在阿尔伯塔省红鹿地区医院中心,静脉注射铁剂的使用率很高,导致非住院病人获得这种药物治疗的机会受到限制,同时也浪费了大量医疗资源:主要目的是比较在门诊环境中接受静脉注射铁剂治疗的患者在实施蔗糖铁剂医嘱组前后的特征,特别是治疗前的实验室检查结果和之前使用口服铁剂的情况。在次要目标方面,比较上述各组患者是否符合缺铁性贫血的诊断标准,是否在治疗前使用过口服铁剂或输血,以及静脉注射铁剂的剂量特征:方法:对 2020 年 1 月 1 日至 2022 年 1 月 31 日期间接受静脉注射铁剂治疗的门诊患者进行回顾性电子病历审查:结果:共有 436 个疗程被纳入分析。在实施蔗糖铁订单组前后,观察到以下治疗前实验室结果:平均血红蛋白 105.8(标准差 [SD] 21.9)克/升与 102.2(标准差 18.5)克/升;平均血球容积 (MCV) 82.2(标准差 9.4) fL 与 79.2(标准差 8.9) fL;铁蛋白中位数 7(四分位距 [IQR] 4-12)微克/升与 6(四分位距 4-11)微克/升。只有 MCV 值的差异具有统计学意义(P = 0.001):结论:对门诊患者实施蔗糖铁剂处方集对处方静脉注射铁剂患者的预处理实验室参数没有显著影响。进一步的管理措施将有助于提高静脉注射铁剂的合理性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Describing and Comparing Patient Factors Associated with Use of Parenteral Iron before and after Implementation of an Order Set for Parenteral Iron (DECODE IRON).

Background: In select clinical scenarios, IV administration of iron is suitable for management of iron deficiency anemia; however, for most patients, oral administration of iron is the mainstay of treatment. At the Red Deer Regional Hospital Centre, in Red Deer, Alberta, high utilization of IV iron has resulted in limited access to this medication for the treatment of ambulatory patients, as well as significant usage of health care resources.

Objectives: The primary objective was to compare patient characteristics, specifically pretreatment laboratory test results and previous use of oral iron, among those receiving IV iron therapy in an ambulatory setting before and after implementation of an iron sucrose order set. For secondary objectives, the aforementioned groups were compared with regard to meeting the diagnostic criteria for iron deficiency anemia, with or without pretreatment oral iron or blood transfusion, and the dosing characteristics for IV iron.

Methods: A retrospective electronic chart review was performed for ambulatory patients who received IV iron between January 1, 2020, and January 31, 2022.

Results: A total of 436 unique treatment courses were included in the analysis. The following pretreatment laboratory results were observed before and after implementation of the iron sucrose order set: mean hemoglobin 105.8 (standard deviation [SD] 21.9) g/L versus 102.2 (SD 18.5) g/L; mean of mean corpuscular volume (MCV) 82.2 (SD 9.4) fL versus 79.2 (SD 8.9) fL; and median ferritin 7 (interquartile range [IQR] 4-12) μg/L versus 6 (IQR 4-11) μg/L. Only the difference in MCV values was statistically significant (p = 0.001).

Conclusions: The implementation of an iron sucrose order set for ambulatory patients did not have a significant effect on pretreatment laboratory parameters among patients for whom IV iron was prescribed. Further stewardship initiatives could be beneficial in improving the appropriateness of IV iron use.

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