Quality standard
Quality statement 1: Iron supplementation
Quality statement 1: Iron supplementation
Quality statement
People with iron-deficiency anaemia who are having surgery are offered iron supplementation before and after surgery.
Rationale
Preoperative anaemia is associated with increased postoperative morbidity and mortality, and with increased transfusion needs. Treating iron deficiency with iron supplements can reduce the need for blood transfusion. This avoids serious risks associated with blood transfusion, for example infection, fluid overload and incorrect blood transfusions being given. It may also reduce the length of hospital stays and the cost to the NHS. Depending on the circumstances, the cause of the iron deficiency should be investigated before or after surgery.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of people with iron-deficiency anaemia who are having surgery and receive iron supplementation before surgery.
Numerator – the number in the denominator who receive iron supplementation before surgery.
Denominator – the number of people with iron-deficiency anaemia who are having surgery.
Data source: NHS Blood and Transplant national comparative audit of NICE quality standard QS138.
b) Proportion of people with pre-operative iron-deficiency anaemia who receive iron supplementation after surgery.
Numerator – the number in the denominator who receive iron supplementation.
Denominator – the number of people with pre-operative iron-deficiency anaemia who have had surgery.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Blood transfusion rates associated with surgery.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (such as primary and secondary care services) ensure that systems are in place to offer iron supplementation before and after surgery to people with iron-deficiency anaemia.
Healthcare professionals (such as doctors, nurses and blood transfusion specialists) offer iron supplementation before and after surgery to people with iron-deficiency anaemia.
Commissioners commission services that offer iron supplementation before and after surgery for people with iron-deficiency anaemia.
People who are having an operation and have anaemia caused by a lack of iron should be offered iron (usually as tablets) before and after the operation.
Source guidance
Blood transfusion. NICE guideline NG24 (2015), recommendations 1.1.2 and 1.1.3
Definitions of terms used in this quality statement
Iron supplementation
People should have their haemoglobin levels checked at least 2 weeks before surgery, if possible and necessary for the procedure they are having. If they have iron-deficiency anaemia, they should be offered iron supplementation. Oral iron should be offered initially, and started at least 2 weeks before surgery. If oral iron is not appropriate, intravenous iron should be considered. [NICE's guideline on blood transfusion, recommendations 1.1.2 and 1.1.3, and expert opinion]