1. 21-May-2014 Iron Infusions in pre op orthopaedic patients Deirdre Doran Colleen McFetridge

2. Auckland District Health Board Background  Approx 33% ID/IDA in ADHB population  Anaemia increases probability of transfusion during or post surgery  ID/IDA requires treatment with iron not RBC!!  Secondary impact of enhanced recovery for patients post surgery

3. Auckland District Health Board Original State  Wanted iron deficient patients undergoing high blood loss orthopaedic procedures referred for IV iron, however × No recent bloods × No process in place × Ad hoc referral system × Referral outcomes not documented

4. Auckland District Health Board Multi-disciplinary Project Team  Deirdre Doran – Anaesthetic Assessment  Amanda Rae – Orthopaedic Outpatients  Colleen McFetridge – Orthopaedic Outpatients  Lizzie Sithole – Orthopaedic Outpatients  Kerry Gunn – Anaesthesia  Karen Patching – Anaesthesia  Tammy Bryan – Performance Improvement  Deba Biswas – Performance Improvement

5. Auckland District Health Board Objectives Early identification of iron deficient patients Timely referral Clear communication No substantial increase in current workload

6. Auckland District Health Board How it was done Workshops held to Map patient journey Decide eligibility criteria Simplify the algorithm Set up documentation Clear roles and responsibilities Clarify data requirements Engaged nursing staff from orthopaedics outpatients Lead taken by Sr. nurses from the orthopaedic clinic Ownership of the process Teaching sessions

7. Auckland District Health Board Process and Algorithm Decision Algorithm Cross Functional Process Flow

8. Auckland District Health Board Referral Form

9. Auckland District Health Board Making the change in clinic  Process simulation/ walk through  Creating awareness  Team brain storming  Teaching sessions  Process aids  Patient information  Reinforcement & evaluation

10. Auckland District Health Board Supporting Documentation Patient Hand-out Reference Aids

11. Auckland District Health Board Results so far  Testing has gone up from a random 10 % to 87% of eligible patients  A further 9% of these patients have been referred for iron infusions

12. Auckland District Health Board Spin offs Increased engagement from staff Improvement of pre admit area Confidence in implementing changes Improved relationships between orthopaedics & anaesthetics Other services now implementing the process Patient satisfaction

13. Auckland District Health Board Next Steps  Rationalizing blood tests  Referral for high ferritin results  Evaluating impact on transfusion  Patient satisfaction survey

14. Thanks