Optimizing Iron Dextran Infusion Protocols to Enhance Efficiency and Patient Throughput in an Outpatient Infusion Center: A Process Improvement Initiative

Presenting Author: Minhee Kang, PharmD, BCPS, BCOP, MedStar Georgetown University Hospital, Washington, DC

Co-Author: Richard Verstraete, RN, MedStar Georgetown University Hospital, Washington, DC

BACKGROUND: Iron dextran 1000 mg is frequently used in our outpatient infusion center to treat iron deficiency anemia,¹ requiring a lengthy 4-hour chair time, including a test dose followed by a 1-hour observation period before administering the full dose.² With increasing patient demand and limited space, reducing the total infusion time became critical to enhance efficiency and patient throughput without compromising safety. Wong and colleagues have demonstrated the safety and efficacy of administering 1000 mg of iron dextran over 1 hour, making it a viable option for streamlining administration.³ A formal discussion of the proposal was presented to the infusion pharmacist, the nurse leader of the outpatient infusion center, and the medical director for our anemia management program. All agreed to our proposal.

OBJECTIVES: To reduce the observation period between the iron dextran test dose and full dose from 1 hour to 15 minutes, ultimately reducing overall chair time and improving workflow efficiency.

METHODS: A literature review of iron dextran protocols was conducted, and key stakeholders, including the infusion pharmacist, nurse leader, and medical director for the anemia management program, discussed and approved the proposal. The intervention, which began in May 2024, was implemented in 2 phases:

• Phase 1: 34 patients had a 30-minute observation period.
• Phase 2: 50 patients had the observation period reduced to 15 minutes.

Retrospective data on wait times, chair times, and adverse events were collected through the electronic health records for patients receiving iron dextran from October 2023 to September 2024 to assess pre- and postintervention outcomes.

RESULTS: A total of 119 doses were assessed preintervention, and 84 doses were assessed postintervention. The intervention resulted in a 22.6% reduction in wait time (from 95 to 73.5 min) and a 26.9% reduction in chair time (from 305 to 222.2 min). In all, 4 minor reactions were reported, with 2 patients discontinuing treatment. All reactions occurred within 10 minutes of the test dose.

The results were not as drastic as expected, primarily due to the need for additional preparation time for the full dose after communication between nurses and pharmacists.

CONCLUSIONS: Shortening the observation period between iron dextran doses improved infusion center efficiency by reducing chair time and increasing patient throughput, without compromising patient safety. However, further improvement is needed by streamlining the preparation process and enhancing communication between nurses and pharmacists to fully realize the potential of reduced wait times. Future steps include staff education, improving preparation times, and ongoing evaluation of outcomes to ensure sustained and further improvements over the next 6 months.

1. Auerbach M, Wong L, McClintock J, et al. Safety and efficacy of rapid (one hour) single intravenous dose low molecular weight iron dextran for treatment of oral iron intolerant maternal iron deficient anemia. Blood. 2015;126:3356.
2. Arastu AH, Elstrott BK, Martens KL, et al. Analysis of adverse events and intravenous iron infusion formulations in adults with and without prior infusion reactions. JAMA Netw Open. 2022;5:e224488. Erratum in: JAMA Netw Open. 2022;5:e2221567.
3. Wong L, Smith S, Gilstrop M, et al. Safety and efficacy of rapid (1,000 mg in 1 hr) intravenous iron dextran for treatment of maternal iron deficient anemia of pregnancy. Am J Hematol. 2016;91:590-593.