P3B214: Increasing Iron Supplementation in Breastfeeding Infants at the 4 Month Health Maintenance Visit in the Pediatric Primary Care Clinic

Purpose/Objectives: To increase transition to iron containing vitamins in infants receiving any breastmilk by 30% from baseline at the 4 month old well child visit in the pediatric primary care clinic.

Design/Methods: We conducted a Quality Improvement project using 3 PDSA cycles. We reviewed charts of all 4 month old infants in the Pediatric Primary Care Clinic pre and post intervention (October 2022- January 2023) to capture data for correct transition to iron containing vitamins. Exclusively formula fed infants were excluded. We performed 3 PDSA cycles - 1. Education on transitioning to iron containing vitamins 2. Email reminders for reinforcement. 3. Introduction of a hard stop phrase in EMR for all 4 months well child visit encounters.

Results: At baseline the iron containing vitamin prescription was at 55.2% (N=76) After PDSA cycle 1 overall prescription rates increased to 72.2%(N=90), after PDSA cycle 2 prescription rates increased to 79.3% (N=169) and after PDSA cycle 3 prescription rates increased to 89.8% (N=147).

Conclusion/Discussion: Lack of education amongst providers and patients, cost of iron supplementation and lack of inclusion of vitamin drops in federal supplemental nutrition program serves as barriers to effective iron supplementation. We conclude that provider education, email reminders and EMR format changes helped effectively improve transitioning to iron containing vitamins in infants receiving any breastmilk. In summary Iron vitamin supplementation can serve as a vehicle for iron fortification in infants not receiving iron rich foods.