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Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres
Author(s) -
Shih A. W.,
Jamula E.,
Diep C.,
Lin Y.,
Armali C.,
Heddle N. M.,
Traore A.,
Doherty J.,
Shah N.,
Hillis C. M.
Publication year - 2017
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/tme.12391
Subject(s) - documentation , medicine , audit , tertiary care , specialty , medical record , retrospective cohort study , pediatrics , family medicine , emergency medicine , management , computer science , economics , programming language
SUMMARY Objective Retrospective audit of IVIG Request Forms in four Ontario tertiary care centres: to determine the case mix of new IVIG requests, to authenticate information provided, and to determine documentation of clinical efficacy. Aims To understand contributors to increases in IVIG utilisation and to determine whether IVIG is being used and monitored appropriately. Introduction Intravenous immunoglobulin ( IVIG ) use in Canada is high compared with other developed countries. We performed a retrospective audit of new IVIG Request Forms across four tertiary care centres in Ontario, one with an active surveillance programme, to determine the case mix, authenticate information provided and assess documentation of efficacy. Methods Consecutive adult patients with a first‐time IVIG request in 2014 were included. The ordering physician specialty, form completeness, documentation of diagnostic criteria for the medical condition and indication for IVIG use and documentation of efficacy were assessed by form and chart review. Results Of 178 patients, the most common indications for IVIG were immune thrombocytopenia (24.2%) and secondary immune deficiency (20.2%). The most frequent prescribers were haematologists (37.6%) and neurologists (10.7%). Other conditions not listed on the form represented 24.2% of cases, with most not indicated in current guidelines. A total of 32.6% of cases overall lacked verification of diagnostic criteria and 51.7% lacked verification for IVIG utilisation criteria, with the number of cases meeting criteria based on documentation being higher at the active surveillance site ( P = 0.005). A total of 19.1% of cases had a discrepancy between the indication written on the form and the documented clinical diagnosis. A total of 18.7% of clinic notes following IVIG had no mention of efficacy. Conclusion Our audit demonstrates a lack of compliance with IVIG Request Form requirements, a lack of documentation of diagnostic criteria and efficacy, and suggests inappropriate use of IVIG . Current implementation of the form may not be sufficient as a strategy for improving appropriate IVIG use.