Implementing a Standardized Screening Algorithm for Iron Deficiency Anemia in Pregnancy

Authors

Ariel Moskowitz, HCA HealthcareFollow
Nicole Tenzel, HCA HealthcareFollow
Joshua Mangels, HCA HealthcareFollow
Lyndsay Millican

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Obstetrics & Gynecology

Document Type

Presentation

Publication Date

2024

Keywords

quality improvement, anemia, pregnancy complications, screening

Disciplines

Hemic and Lymphatic Diseases | Medicine and Health Sciences | Obstetrics and Gynecology | Quality Improvement

Abstract

OBJECTIVE: Anemia in pregnancy is a global health problem and complicates >40% of pregnancies. Anemia is associated with significant maternal and fetal complications including low birth weight, preterm delivery, postpartum hemorrhage, ICU admissions, need for blood transfusion, and maternal morbidity. The American College of Obstetricians and Gynecologists (ACOG) and the CDC recommend screening for anemia at the first prenatal visit and again between 24 and 28 weeks gestation. The aim of this quality improvement project is to improve compliance of screening for anemia in pregnancy amongst the providers of Medical City Women's Care. METHODS: Using the Plan-Do-Study-Act (PDSA) quality improvement methodology, this project was developed to improve screening for anemia in pregnancy. We reviewed current recommendations from ACOG and the CDC to determine our screening protocol to include checking a CBC at each patients' initial prenatal visit, between 24-28 weeks gestation, and upon admission to the hospital for labor and delivery. We also implemented global screening for underlying hemoglobinopathies by performing a hemoglobin fractionation cascade at the initial prenatal visit. Providers and Medical Assistants at Medical City Women's Care were instructed on ordering CBC and hemoglobin fractionation at each patients' initial OB visit and an additional CBC between 24-28 weeks gestation. Laboratory order forms were updated with these recommendations and posted on all computer workstations. Comparison of pre-intervention and post-intervention compliance to the above screening protocol was performed. RESULTS: This study included 138 obstetrical patients from the Medical City Women's Care Clinic who established care prior to 20 weeks gestation between July 2023 and January 2024. We identified 3 patients with underlying hemoglobinopathies and 8 patients with baseline anemia at the initial prenatal visit. Compliance for screening for underlying hemoglobinopathy increased to 77%. Results for compliance of screening for anemia between 24-28 weeks gestation are pending, however we are anticipating a nearly 100% compliance rate based on preliminary data. CONCLUSION: Implementation of this project allowed us to improve screening for anemia in our obstetrical population at Medical City Women’s Care. This resulted in early detection of anemia which ultimately will lead to early treatment and improved admission hemoglobin at time of delivery. Prospective data from this study will be used to design a research project comparing admission hemoglobin pre- and post-QI implementation with the hopes of decreasing rates of blood transfusion in the immediate postpartum period.

Original Publisher

HCA Healthcare Graduate Medical Education

Comments

1st Place - Quality Improvement Category

Recommended Citation

Moskowitz, Ariel; Tenzel, Nicole; Mangels, Joshua; and Millican, Lyndsay, "Implementing a Standardized Screening Algorithm for Iron Deficiency Anemia in Pregnancy" (2024). North Texas GME Research Forum 2024. 10.
https://scholarlycommons.hcahealthcare.com/northtexas2024/10