Appendix 5 – Midwives supplying ferrous sulfate or ferrous gluconate for women meeting criteria for supplemental iron therapy

The aim of asking community midwives to provide ferrous sulphate or ferrous gluconate tablets to people on their caseload meeting criteria is:

  • The potential to increase compliance when women can be issued with an immediate supply which could:
  • ■ Reduce the rates of Ferinject administered and associated costs (approx. 260 Ferinject per year in the antenatal period at the cost of £40,000 (£150 each) - not considering costs of attendance on DAU, admission, clerking etc and postnatal Ferinject infusions).
  • Reduce the co-morbidities associated with anaemia around the time of birth.
  • Currently a prescription is sought via the GP which is time costly and inefficient – pregnant people are then poorly complaint/do not collect their prescription/GP queries the prescription, therefore midwives time would be maximised.
  • Reducing barriers to medicines compliance – physical barriers (attending GP/pharmacy to collect prescription), administering barriers (the prohibitive process of requesting a prescription via the GP which can then be queried/not done), lack of understanding of indication/side effects – the midwife can address these.
  • The legal framework is already in place to support this – ‘Midwives can supply all general sale list medicines (GSL) and pharmacy medicines (P) in accordance with their scope of practice. Medicines not included in midwives’ exemptions (this includes GSL, pharmacy (P) and specified POM medicines), require a prescription, a patient-specific direction (PSD) or patient-group direction (PGD).’ Ferrous sulphate is a ‘P’ class medicine.
  • Increase health promotion when midwives can ‘close the loop’ and give advice on administration/maximising absorption/diet.

PROCESS:

  • To be ordered as TTO's via the POP application.
  • To be stored in a locked cupboard in a lockable room.
  • Pregnant people to be administered with an initial supply (1 pack/28 tabs = 1 month), ensuring the person's identifiable sticker is placed next to then instructions on how to take them.
  • Hb to be re-checked after 6 weeks.
  • Repeat prescription arranged via GP if required.

Anaemia and iron deficiency: Diagnosis and Treatment throughout Pregnancy, Labour and Postpartum Period Clinical Guideline V4.3