Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;192(3):1241-1247.
doi: 10.1007/s11845-022-03103-w. Epub 2022 Jul 23.

'Closing the loop': re-audit of the diagnosis and management of vitamin B12 deficiency in general practice

O O'Donnell  1 , J MacCarthy  2
Affiliations

'Closing the loop': re-audit of the diagnosis and management of vitamin B12 deficiency in general practice

O O'Donnell et al. Ir J Med Sci. 2023 Jun.

Abstract

Introduction: Vitamin B12 deficiency is common in Ireland, The Irish Longitudinal Study on Aging (TILDA) survey indicates 12% of over 50s in Ireland are low or deficient. The condition is commonly managed exclusively in general practice.

Aim: The intention of this audit was to establish whether B12 deficiency is diagnosed correctly and whether there was over-treatment of patients.

Methods: The audit was conducted in an urban general practice in midwest Ireland. The primary limitation was the low number of patients. Thirty-five patients were included after practice database searches. An initial audit was performed which compared with the standard, Royal University of Bath: 'Guidelines for the Investigation & Management of B12 deficiency'.

Results: The recommendations from this audit were to complete follow-on investigations and to switch over patients from IM to oral replacement. Twenty-one patients were then recalled, and investigations were performed. Ten patients were then switched from IM replacement to oral therapy. A re-audit was then completed. The re-audit showed marked improvement in compliance, from 17% (n = 6) to 83% (n = 29). The reduction in patients on IM therapy will decrease practice burden, with an annual reduction of nurse consultations by 46, representing a 30% decrease in nurse consultations for IM vitamin B12. This equates to an annual cost reduction of €1,340.

Conclusion: This closed loop audit demonstrated that there was over treatment and under investigation of patients with B12 deficiency in general practice and that auditing of this process could both reduce risk for patients and save money and time.

Keywords: Closed loop audit; General practice; Ireland; Primary care; Vitamin B12 deficiency.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Jan 2019 audit: actual versus guideline management plans
Fig. 2
Fig. 2
Jan 2019 audit compliance measurement
Fig. 3
Fig. 3
Jul 2019 audit: actual versus guideline management plans
Fig. 4
Fig. 4
Jul 2019 audit compliance measurement
Fig. 5
Fig. 5
Modified NHS bath flowchart
Fig. 6
Fig. 6
Jan 2019 audit data collection form
Fig. 7
Fig. 7
Jul 2019 re-audit data collection form
See this image and copyright information in PMC

References

    1. Laird E, O'Halloran A, Carey D et al (2018) Voluntary Fortification is ineffective to maintain the vitamin B12 and folate status of older Irish adults: Evidence from the Irish Longitudinal Study on Aging (TILDA). British J Nutrit 120(1):111–120. available: 10.1017/S0007114518001356 - PubMed
    1. Knechtli CJC, Crowe JN (2010) Guidelines for the investigation & management of vitamin B12 deficiency. Royal University Bath NHS Trust, available: http://www.ruh.nhs.uk/For_Clinicians/departments_ruh/Pathology/documents... . [accessed 29 Jan 19]
    1. Ankar A, Kumar A (2019) Vitamin B12 deficiency (Cobalamin). [Updated 2019 Jan 11], Treasure Island, FL: StatPearls Publishing. Available: https://www.ncbi.nlm.nih.gov/books/NBK441923/ . [accessed 08 Jul 19]
    1. Health Service Executive (HSE) (2019) Healthcare audit [quality assurance and verification]. Healthcare Audit Standards. April 2019. https://www.hse.ie/eng/about/who/audit-service/healthcare-audit-standard... [accessed 11 Jul 22]
    1. Health Service Executive (HSE) (2008) Quality and patient safety directorate. Daly, Majella Clinical Audit Criteria and Guidance Working Group. August 2008. https://www.hse.ie/eng/about/who/qid/quality-and-patient-safety-document... . [accessed 11 Jul 22]

LinkOut - more resources