P.78 Tackling antenatal anaemia: a quality improvement project

Baban, N.; Oliver, C.; James, K. E.; Robb, A.; Lloyd, L.; Rayment, R.; Bell, S.

Introduction: Antenatal anaemia contributes to significant perinatal morbidity.1 In March 2020 a revised antenatal anaemia pathway was implemented in anticipation of reduced blood stocks due to COVID-19. Changes included alternate day oral iron for all patients from booking, measurement of ferritin at booking and 28 weeks and a revised intravenous (IV) iron pathway. Baseline data were compared with re-audit data following pathway adoption to assess the impact on anaemia, ferritin levels and blood transfusion. Methods: Following local audit approval, anonymous data collection was performed using the electronic maternity database (Euroking), blood bank and electronic patient records. Haemoglobin (Hb) and ferritin results in the month of May (baseline data) and November (Nov, re-audit) were compared, in addition to red blood cell transfusion data. Booking (10–14 weeks’ gestation), 28 week (27–30 weeks’ gestation) and term bloods (37 weeks’ onwards) were collected. Categorical data were analysed using chi-squared test and continuous data compared using unpaired students T-test (Microsoft Excel). Results: Mean Hb results are summarised in the Table. Term Hb was recorded in [Formula presented]8% of women in both audits. The number of women with Hb [Formula presented]05g/L at term was 9.1% in May vs 7.1% in Nov ([Formula presented]= 0.37), whilst blood transfusion was administered in 3.4% vs 2.6% ([Formula presented]= 0.66). More than 90% of women had a booking ferritin in both audit cycles, with a mean (SD) of 42.4 (34.3) [Formula presented]/L in May vs 41.8 (31.4) [Formula presented]/L in Nov ([Formula presented]0.80). The mean (SD) ferritin at 28 weeks in May vs Nov was 14.4 (11.3) [Formula presented]/L vs 14.1 (7.4) [Formula presented]/L, with [Formula presented]6% of women with tests recorded in May but only 20% in Nov. [Formula presented] Discussion: Following implementation of a new anaemia pathway an increase the in mean Hb at term was observed, with a non-significant reduction in the proportion of women with anaemia (Hb[Formula presented]05 g/L). The baseline 28-week ferritin was low and despite routine oral iron prescription this did not increase in the Nov cohort, although there was a substantial reduction in the number of ferritin results available due to problems with community sampling. The pathway included changes to both oral and IV iron prescription. Additional qualitative and quantitative data is now required to understand pathway adherence (including patient compliance) and to inform the impact of individual interventions.