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Intravenous Iron at Home set NHS Kidney Care

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					   E-Seminar 12th July 2011
Intravenous Iron at Home
       Sharon Benton
   Anaemia Nurse Specialist
        Association
         Guidelines for iron management:


•   ‘In appropriate circumstances, iron treatment
    can also be administered in the community.’

•   ‘When managing the treatment of people with
    anaemia of CKD, there should be agreed
    protocols defining roles and responsibilities of
    healthcare professionals in primary and
    secondary care.’

         NICE: ‘Anaemia Management in people with chronic kidney disease’ Sept 2006, update 2011
       Savings delivered:
• 2010 – 1302 saved hospital visits
based on 217 pts seen in community, avg 6 doses
  each = (217 x 6=1302 )

• An estimate of 33% of patients would need hospital
  transport or recoup travel costs

• Cost to PCT for each hospital visit = £113, 1302
  visits = £147,126, average transport cost per journey
  = £10 (1302x33% at £10x2 = £8,594)

• Total estimated savings = £155,720
                              Local data:
        Total number of patients referred for community given iron

                250
                200
                150
Nu of pts
                100
                 50
                  0
                          2007           2008             2009            2010
                                                Year
                                      2007    2008     2009      2010

   40
   35
   30
   25
   20
   15
   10
    5
    0




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           Policy development:
• Local policy:
‘Administering Intravenous Iron Supplementation To Pre-Dialysis,
   Transplant and Peritoneal Dialysis Patients’ (Using Iron III
   Hydroxide Sucrose Complex-Venofer) – 2002

• Ammended to include community use 2003
‘Test Dose Procedure: The test dose is not to be given in the
   community.’

•   Test dose of Iron – secondary care

• Subsequent doses of Iron – primary care
(medical cover & anaphylaxis kit)
       Anaphylaxis treatment
• Treatment
  ‘Stop administering the iron, fast bleep a doctor,
   prepare hydrocortisone, anti-histamine and
   adrenaline drugs.’

‘( If Venofer is being given in the community, the
   above should be followed and the patient’s G.P
   should be contacted immediately or dial 999
   depending on the severity of the reaction rather
   than a doctor being fast bleeped.)’
       Patient groups

• Pre dialysis

• Post transplant

• Peritoneal dialysis

• Cardio renal
      Process to introduce IV iron in the
          community in Cornwall:

1.   Identify community site for iron administration

2.   Obtain agreement to administer (First line of contact
     head of dept or matron )

3.   Finance agreement (Drug costs, session payment, etc)

4.   Nursing Competences – ‘A Guide to the administration of
     intravenous iron for people with anaemia of chronic kidney
     disease (CKD) in a non acute hospital setting.’ (pg 16-20, 2009)
    Administration of Iron:
• Staff qualification (venopuncture, cannulation)

• Drug prescription (who provides)

• Supply of drug (how to order)

• Evidence of administration (documentation)

• Communication to G.P
                 Strengths & Weaknesses

               Strengths                             Weaknesses

Direct quick initial set up              No business case submission,
                                         negative impact on financial status
Care closer to the patients home

Less risk of hospital acquired           Loss of revenue
infections
Promoting greener environment

Sustainable service                      Funding of drug (2010 = £22,785)

Reduction in waiting time/able to free
up hospital site for other services

Community staff have improved renal
knowledge base

Seamless service by single person        Time to organise service by
co-ordination                            secondary care is not recognised
            Conclusion:
• More patients require IV iron alone to
  maintain Hb >11.0 without the need for
  ESA
New patient iron referrals:
14% required ESA 2008, 16% in 2009
& 12.5% in 2010

• From 2008 to 2010 14% of patients given
  IV iron required a subsequent course
http://www.evidence.nhs.uk/ab
   outus/Pages/AboutQIPP

  ‘Giving intravenous iron in patients
   homes and community hospitals’

				
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