Rationale, aims and objectives: Iron sucrose remains a top expenditure in Fraser Health Authority. Audit data from an iron sucrose standardized order set (SSO) pilot coupled with the addition of iron isomaltoside to formulary resulted in the implementation of a regional SSO. Survey objectives were to clarify how iron infusion referrals are triaged, determine iron infusion wait times and identify what other services can impact wait times prior to regional SSO implementation. Method: Information was collected from a web-based survey sent to outpatient unit staff at all 11 sites within the health authority Results: Survey response rate was 73%. Urgent and non-urgent referral definitions varied and included laboratory parameters, prescriber specification, consideration of procedure dates and evidence of symptoms. Urgent referrals wait times are usually within the same week and non urgent wait times varied from same week booking to up to 3 months. Outpatient units provide a multitude of services that require urgent appointment times that may require scheduling ahead of non-urgent iron infusion referrals. Outpatient clinics deal with multiple other clinical reasons other than iron infusions which contribute complicate the triage and booking process and can lead to long wait times. Wait time reduction could be the result of utilizing a SSO that displayed all the information required by clinic staff and streamlined the booking process rather than the addition of iron isomaltoside to formulary. Conclusions: With the implementation of a regional SSO the iron infusion referral process may be simplified, thereby shortening appointment wait times. It is recommended that comparable information regarding iron infusion wait times be collected after these changes in practice.

ii. Rationale, aims and objectives Fraser Health, a large health authority, undertook an audit of standardized order sets (SOS) listing ranitidine due to the Health Canada recall of ranitidine. Our primary objective was to determine if ranitidine use on SOSs was supported by the best available evidence, in order to sparingly use ranitidine in the hospital. ii. Method Two evaluators recorded the indication of ranitidine on every SOS and a scoping review of systematic review evidence was conducted in parallel to a comprehensive review of evidence quality. Clinical practice guideline recommendations were also recorded in order to make comparisons to systematic review evidence. iii. Results Twenty-seven SOSs were found. Seven SOSs (26%) clearly indicated the medical condition ranitidine was being used for. Twenty SOSs (74%) did not list an indication or had an unclear indication. Six SOSs (22%) were supported by systematic review evidence: 4 intensive care unit (ICU) SOSs for stress ulcer prophylaxis, 1 nausea and vomiting of pregnancy SOS for heartburn, and 1 emergency department SOS for heartburn iv. Conclusion The SOS ranitidine audit conducted at Fraser Health has highlighted inconsistencies between institutional prescribing policies and evidence. Drugs listed on SOSs should be carefully considered before being used at an institutional level. To aid prescribers’ decision making, it may also be beneficial to indicate what the purpose of each drug is on a SOS Our team plans to use this as an opportunity to revise other ranitidine SOSs to reflect best evidence. Evaluation of how ranitidine or other drugs were being prescribed from SOSs is encouraged.