Clinical Audit of Prescribing Administration and Monitoring of Intravenous Ferric Carboxymaltose in an University Hospital Kerry

Background: Iron-deficiency anaemia is common and clinically important. Intravenous ferric carboxymaltose permits rapid iron replacement when oral iron is ineffective, not tolerated or unsuitable, but safe use depends on documented indication, weight- and haemoglobin-informed dosing, appropriate dose intervals, precautions, administration monitoring and follow-up.

Objective: To evaluate compliance with evidence-based and product-information standards for ferric carboxymaltose prescribing, administration and monitoring in adults at University Hospital Kerry.

Methods: A prospective clinical audit included 53 consecutive eligible adult inpatient, day-case and ambulatory-care episodes from 9 to 20 July 2026. Twelve criteria derived from local policy, the Summary of Product Characteristics and relevant guidance were assessed from medical records, prescriptions, administration records and laboratory systems. Results are reported as proportions with Wilson 95% confidence intervals.

Results: Laboratory confirmation of iron deficiency and monitoring during or after administration were documented in 53/53 episodes (100% each). Avoidance of ferric carboxymaltose in anaemia not attributable to iron deficiency and compliance with the licensed maximum dose were each achieved in 46/53 (86.8%). Documentation was lower for indication (40/53, 75.5%), investigation or documentation of the underlying cause (36/53, 67.9%), planned follow-up (33/53, 62.3%), review of contraindications and precautions (30/53, 56.6%) and consideration of phosphate monitoring (30/53, 56.6%). Only 20/41 applicable repeat-dose episodes (48.8%) met the minimum 7-day interval. Body weight was documented in 7/53 (13.2%), and total iron requirement was calculated and documented in 3/53 (5.7%).

Conclusion: The audit identified reliable laboratory confirmation and peri-administration monitoring but major weaknesses in traceable individualised dosing, repeat-dose timing and follow-up planning. A standardised request and prescription form with mandatory weight, haemoglobin, indication, dose calculation, interval, risk-based phosphate assessment and follow-up fields is the principal improvement intervention. Re-audit after implementation is required to determine its effect.