P24
THE INTRODUCTION OF AN INTRAVENOUS (IV) IRON ADMINISTRATION
PROGRAMME IN PRIMARY CARE
Corner, L1, Smith, S2, Tannahill, N1.
1
The Royal Liverpool and Broadgreen University Hospitals NHS Trust, 2Liverpool Primary
Care Trust
PROBLEM: From this renal unit’s experience, the number of patients referred for IV iron
treatment has increased year on year since the inception of an iron clinic in 2001. This has resulted
in increased waiting times for treatment and the need for patients to travel to the main renal unit site
for iron injections. From a financial perspective there was to be a real cost burden to the local
health economy, as patient attendance at a nurse led clinic was to be recharged to the primary care
trust (PCT). The local community IV therapy team was developed in 2000 to reduce the numbers
of patients using hospital services solely for intravenous therapies and were keen to expand their
service provision and diversify their skill set.
PURPOSE: To provide an IV iron administration service within primary care, thereby reducing
the number of patients travelling to the renal unit for routine iron treatment. To develop an IV iron
service locally accessible to patients without the need for the use of hospital transport or repeated
attendance to the main renal unit. To minimise the financial impact on the PCT of this essential
service, by developing a partnership with the established community team who will undertake IV
iron administration.
DESIGN: In collaboration with the community IV therapy team a comprehensive protocol for IV
iron administration was developed and approved by the local medicines management committee.
Training and education for the community nursing team was provided by attendance and
participation in the iron clinics run by the anaemia co-ordinator within the renal unit. The first dose
of iron (test dose) is administered within the renal unit iron clinic and a referral faxed to the
community team for continuation of the course of treatment. The medication required to complete
the course is supplied to the patient by the renal unit at their first appointment. Injections are
administered to patients as a 200mg bolus injection over 10 minutes at weekly intervals up to a total
of 5 injections (1000mg). A ferritin level is checked between injections 4 and 5 to determine the
total dose of iron required.
FINDINGS: Since the inception of the service in May 2005, 180 people requiring IV iron
treatment have been treated by the community IV therapy team (up to September 2007). The
majority of these people received treatment within their own home. 15 of these patients have been
referred for a second course of iron. Waiting times for iron injections have now reduced to less
than 2 weeks. The success of this programme has resulted in the service expanding to the other
PCTs who commission renal services from this main unit. This has enabled the anaemia coordinator to concentrate on patients who respond poorly to anaemia treatment strategies.
RELEVANCE: This innovative service demonstrates the advantages of partnership working
across primary and secondary care systems. The development of a community iron service by an
established team has reduced patient waiting times for treatment and minimised the inconvenience
to patients. This development of service has embraced the underlying ethos of the renal NSF and
NICE guideline for managing people with anaemia in chronic kidney disease by the provision of a
service local to the patient’s home.