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Treatment of Anemia During Pregnancy - Adult/Pediatric - Ambulatory [68]

Treatment of Anemia During Pregnancy - Adult/Pediatric - Ambulatory [68] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 68

Delegation Protocol Title:
Treatment of Anemia During Pregnancy – Adult/Pediatric – Ambulatory

Delegation Protocol Applies To:
UW Health Obstetrics and Gynecology Clinics and Family Medicine Clinics with OB/Gyn Services

Target Patient Population:
Pregnant Women

Delegation Protocol Champions:
Makeba Williams, MD – Obstetrics and Gynecology (OB/GYN)
Jacqueline Gerhart, MD – Department of Family Medicine

Delegation Protocol Reviewers:
Jenny Accola, RN, BSN – Clinic Coordinator - UW OB/GYN
Linda Kiefer, RN – Clinical Supervisor – UW Health – Deforest-Windsor Clinic

Responsible Department:
Department of Obstetrics and Gynecology
Department of Family Medicine

Purpose Statement:
To delegate authority from the patient’s OB/GYN or Family Medicine provider to Registered Nurses (RNs) to
initiate treatment of anemia in pregnant patients.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This delegation protocol is initiated when a pregnant patient is determined to have anemia based upon
Hemoglobin (Hgb) or Hematocrit (Hct) results. .
2. Anemia is determined using the following are parameters:
2.1. Non-African Descent
Trimester Hemoglobin
(g/dL)
Hematocrit
(%)
1
st
2
nd
3
rd

2.2. African Descent
Trimester Hemoglobin
(g/dL)
Hematocrit
(%)
1
st
10.2 31
2
nd
9.7 30
3
rd
10.2 31
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


2.2.1. If below these levels the RN will order iron sulfate ( FeSO4) 325mg orally twice daily along with
docusate (Colace) 100mg by mouth twice daily and order a repeat Hgb and Hct in one month.
2.2.2. If patient complains of dyspepsia, the RN will recommend antacids with calcium orally, as directed.
Take antacids 30 minutes after iron supplement.
2.3. If the patient has Hgb less than 9.0 g/dl or mean corpuscular volume (MCV) less than 80fl, or if patient
has known hemoglobinopathy diagnosis the RN will contact the provider.

Order Mode: Cosign Required, Protocol/Policy

References:
1. The American College of Obstetricians and Gynecologists, Standards for Obstetric-Gynecologic Services 7th
edition 2012
2. Anemia in pregnancy. ACOG Practice Bulletin no. 95. American College of Obstetrics and Gynecology. Obstet
Gynecol 2008;112:201-208. Reaffirmed 2015

Collateral Documents: NA

Approved By:
UW Health Ambulatory Protocol Committee: January 2012; *March 2014; *November 2016
UWHC Lab Practices Committee: February 2012; *August 2014; *November 2016
UWHC Pharmacy & Therapeutics Committee: March 2012; *August 2014; *November 2016
UWHC Medical Board: April 2012; *August 2014; *November 2016
UW Health Chief Clinical Officer: *August 2014: *November 2016

Effective Date: December 2016

Scheduled For Review: December 2018
*Expedited review process

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org