PMID- 28144996
OWN - NLM
STAT- MEDLINE
DCOM- 20170724
LR  - 20170724
IS  - 1365-3148 (Electronic)
IS  - 0958-7578 (Linking)
VI  - 27
IP  - 2
DP  - 2017 Apr
TI  - Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario 
      tertiary care centres.
PG  - 122-131
LID - 10.1111/tme.12391 [doi]
AB  - 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.
CI  - (c) 2017 British Blood Transfusion Society.
FAU - Shih, A W
AU  - Shih AW
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Jamula, E
AU  - Jamula E
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Diep, C
AU  - Diep C
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Lin, Y
AU  - Lin Y
AD  - Department of Clinical Pathology, Sunnybrook Health Sciences Centre and 
      Department of Laboratory Medicine and Pathobiology, University of Toronto, 
      Toronto, Ontario, Canada.
FAU - Armali, C
AU  - Armali C
AD  - Department of Clinical Pathology, Sunnybrook Health Sciences Centre and 
      Department of Laboratory Medicine and Pathobiology, University of Toronto, 
      Toronto, Ontario, Canada.
FAU - Heddle, N M
AU  - Heddle NM
AD  - Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
AD  - Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.
FAU - Traore, A
AU  - Traore A
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Doherty, J
AU  - Doherty J
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Shah, N
AU  - Shah N
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
FAU - Hillis, C M
AU  - Hillis CM
AD  - McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, 
      Canada.
AD  - Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170131
PL  - England
TA  - Transfus Med
JT  - Transfusion medicine (Oxford, England)
JID - 9301182
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adult
MH  - Female
MH  - Humans
MH  - *Immunoglobulins, Intravenous
MH  - Male
MH  - *Medical Audit
MH  - *Medical Records
MH  - Ontario
MH  - Retrospective Studies
MH  - *Tertiary Care Centers
OTO - NOTNLM
OT  - IVIG
OT  - blood safety
OT  - haemovigilance
OT  - immunoglobulins
OT  - plasma derivatives
OT  - practice audit
OT  - transfusion medicine
EDAT- 2017/02/02 06:00
MHDA- 2017/07/25 06:00
CRDT- 2017/02/02 06:00
PHST- 2016/10/26 00:00 [received]
PHST- 2016/12/29 00:00 [revised]
PHST- 2016/12/30 00:00 [accepted]
PHST- 2017/02/02 06:00 [pubmed]
PHST- 2017/07/25 06:00 [medline]
PHST- 2017/02/02 06:00 [entrez]
AID - 10.1111/tme.12391 [doi]
PST - ppublish
SO  - Transfus Med. 2017 Apr;27(2):122-131. doi: 10.1111/tme.12391. Epub 2017 Jan 31.