Iron Autofill

Sample Iron Infusion Protocol Autofill for Patient Notes

Referred for Iron Infusion by =

Haemoglobin =

Iron =

Ferritin =

Symptoms =

Indications (e.g. Imminent surgery, rapid iron depletion, lack of efficacy or tolerance or compliance of oral iron, malabsorption, CKD, CHF) =

Contraindications (e.g. anaemia due to other causes, iron overload, known hypersensitivity, patient age <14, first-trimester pregnancy) =

Precautions (e.g. significant liver dysfunction, acute or chronic infection, asthma or atopic allergies, pregnancy, risk of paravenous leak, chronic inflammatory states, risks with hypophosphataemia) =

Risks discussed

Common (Less than 10%) = Headache, dizziness, flushing, nausea, site reactions, hypophosphataemia

Uncommon (Less than 1%) = Skin staining, numbness, tingling, taste change, fast heart rate, shortness of breath, fever

Rare (Less than 0.1%) = Malaise, vertigo, syncope, anxiety, angioedema

Very rare = Anaphylaxis at 1 in 250,000

IVC inserted

Arm =

Gauge =

10mL normal saline flushed without pain or resistance

Iron given via slow IVI. Ferinject dose =

Monitored post infusion

Side effects =

Advised to seek help if any concerns

Follow up with original referrer or GP in 4 to 6 weeks

Patient leaflet given

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