Paediatric Resident Icahn School of Medicine at Mount Sinai Astoria, New York, United States
Background: Full term infants require supplemental iron beginning at 4 months of age due to exhaustion of maternal iron stores. The American Academy of Pediatrics (AAP) recommends that all breast-fed infants receive iron supplementation of 1 mg/kg per day. [1] Objective: To increase transition to iron containing vitamins in infants receiving any breastmilk by 30% from baseline over 4 months. Design/Methods: We conducted a quality improvement project using 3 PDSA cycles. We reviewed charts of all 4 month old infants in the Pediatric Primary Care Clinic pre and post intervention to capture data for correct transition to iron containing vitamins. Exclusively formula fed infants were excluded. We performed 3 PDSA cycles - 1. Education on transitioning to iron containing vitamins 2. Email reminders for reinforcement. 3. Introduction of a hard stop phrase in EMR for all 4 months well child visit encounters. Results: At baseline the iron containing vitamin prescription was at 55.2%. After PDSA cycle 1 overall prescription rates increased to 72.2%, after PDSA cycle 2 prescription rates increased to 79.3% and after PDSA cycle 3 prescription rates increased to 89.8%.
Conclusion(s): Education, email and EMR format changes helped improve effective transitioning to iron containing vitamins.
References: Baker, Robert D. MD, PhD & Greer, Frank R. MD, The Committee on Nutrition. (2010, November). Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0–3 Years of Age). Pediatrics Volume 126, Issue 5. https://doi.org/10.1542/peds.2010-2576
