title: Audit of provincial IVIG Request Forms and efficacy documentation in four Ontario tertiary care centres.
abstract: 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.
  
  
  OBJECTIVE
  To understand contributors to increases in IVIG utilisation and to determine whether IVIG is being used and monitored appropriately.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: A W
authors.initials: AW
authors.lastname: Shih
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Jamula
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Diep
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Armali
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.|McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.|Centre for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.
authors.forename: N M
authors.initials: NM
authors.lastname: Heddle
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Traore
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Doherty
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Shah
authors.affiliation: McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.|Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: C M
authors.initials: CM
authors.lastname: Hillis
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D009864:Ontario; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: IVIG; blood safety; haemovigilance; immunoglobulins; plasma derivatives; practice audit; transfusion medicine