Aim: Iron deficiency anaemia is a common medical problem in pregnancy. In women delivering their babies at the Women’s and Children’s Hospital (WCH) in 2015, only 3.2% of non-anaemic patients needed a blood transfusion whereas anaemic women had a six times higher chance of needing a blood. The rate of anaemia at delivery (12.3%) was higher than peer hospitals and anaemic patients at delivery had three times higher chances of being transfused compared to those who are not. The obstetric transfusion rate at the WCH was approximately double NSW state-wide published data (1.4%). The WCH in conjunction with the Red Cross Blood Service initiated a clinical practice improvement project to improve blood product management in obstetrics. The aim was to optimise antenatal haemoglobin and iron stores in 100% of women coming into labour and increase oral iron therapy in women diagnosed with iron deficiency.
Methods: Haemoglobin assessment and optimisation flowcharts and a patient handout were prepared and distributed along across the antenatal, delivery and postnatal wards at the WCH. Maternity staff were educated using the CPI tools from November 2016 to January 2017. A telephone audit of 30 women diagnosed with iron deficiency was carried out to assess diagnosis and awareness and whether the patient handout was useful.
Results: Haemoglobin and ferritin tests increased at each trimester, with 67% of ferritin results confirming iron deficiency. Rates of anaemia at delivery decreased from 16.1% in 2014 to 11.5% in December 2016 (during the pilot project).
Conclusions: Adaptation of the above tools and education of staff and patients provided positive practice improvements in optimisation of haemoglobin and iron levels in obstetric patients, as well as decreased red cell transfusions.