Development, implementation and impact of an immunoglobulin stewardship programme in Saskatchewan, Canada.

BACKGROUND AND OBJECTIVES: Intravenous immunoglobulin (IVIG) is one of the most costly and limited-supply blood products. Judicious use of this therapy is important to ensure a continued supply is available for patients in need. The Saskatchewan IG Stewardship Program was initiated to monitor and reduce inappropriate IG use. MATERIALS AND METHODS: The Program was developed and implemented through the collaborative efforts of a multidisciplinary, inter-organizational team. Funding was provided from provincial organizations to create new positions within the Program and to support stakeholder engagement throughout the process of implementation. Data were collected from local and national databases regarding the amount of IVIG used and appropriateness of orders based on published criteria. RESULTS: Over 20 months, the Program helped to reduce unnecessary IVIG use from pre-intervention levels by more than 20%. Interventions from nurse navigators alone reduced inappropriate IVIG use by 2.6%. During the 20-month period following Program initiation, more than 4 million CAD less was spent on IVIG compared with the previous 20 months. CONCLUSION: The Saskatchewan IG Stewardship Program has led to more appropriate IVIG use across the province, more effective preservation of this limited healthcare resource, and cost savings that more than cover the cost of administering the Program.

Determining the validity of non-invasive spot-check hemoglobin co-oximetry testing to detect anemia in postpartum women at a tertiary care centre, a prospective cohort study.

BACKGROUND: Spot-check hemoglobin co-oximetry analyzers measure hemoglobin transcutaneously and offer the benefit of a hemoglobin measurement without phlebotomy. The objective of this study was to determine the validity of non-invasive spot-check hemoglobin co-oximetry testing for the detection of postpartum anemia (hemoglobin < 10 g/dL). METHODS: Five hundred eighty-four women aged 18 and over were recruited on postpartum day one following a singleton delivery. Two non-invasive spot-check hemoglobin co-oximetry monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value. RESULTS: Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a bias of + 2.4 (± 1.2) g/dL with the Pronto and + 2.2 (± 1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for the Pronto and 16% for the Rad-67. Adjusting for the fixed bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%. CONCLUSION: A consistent overestimation of hemoglobin by the non-invasive spot-check hemoglobin co-oximetry monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.