Assessing Prescribing Trends and Pharmacist Role in Optimization of IV Iron Sucrose

Background: Iron deficiency can occur in the presence or absence of anemia and is defined as ferritin less than 15–30 μg/L or transferrin saturation less than 20% per the American Society of Hematology guidelines. Intravenous (IV) iron is used to treat iron deficiency when oral iron supplements are ineffective or not tolerated due to gastrointestinal issues or inability to take medications orally. Intravenous iron allows for more rapid replenishment of iron stores, especially in cases where absorption is compromised. There is no significant difference in efficacy between IV iron formulations, making cost-effectiveness a crucial consideration in product selection. Our health system has two inpatient formulary IV iron products: iron sucrose (Venofer®) and sodium ferric gluconate (Ferrlecit®). An institutional protocol that guides product selection based on patient-specific factors outlines specific criteria for use. Sodium ferric gluconate is the preferred IV iron product, while high-dose IV iron sucrose is reserved for patients with severe iron deficiency. Adherence to the protocol has been identified as an opportunity for improvement. This project aimed to assess the prescribing practices and the pharmacist’s role in ensuring adherence to IV iron sucrose criteria for use. Methods: This was a single-center evaluation of prescribing practices with adherence to the inpatient IV iron protocol and iron sucrose criteria. The principal investigator educated pharmacists on the protocol by using a 10-minute in-service. A review of IV iron sucrose orders for adults was conducted from January to March 2024. Any orders for patients in the emergency department or observation areas were excluded. The primary outcome was the percentage of compliance with the criteria for use, and the secondary outcomes were the number of pharmacist interventions and cost savings associated with the optimization of IV iron sucrose. Results: The percentage of compliance with the prescribing criteria increased from 66% to 100% with pharmacist intervention. A total of 43 orders required pharmacist intervention to optimize IV iron per the protocol. Throughout the project, IV iron sucrose optimization generated cost savings of approximately $7,965, which can be extrapolated to $48,000 in annual cost savings. Conclusion: The results of this evaluation demonstrate the impact of pharmacist intervention on ensuring compliance with the use protocol criteria for IV iron sucrose. The cost savings associated with IV iron sucrose optimization showed the benefit of pharmacist intervention.