From Infusion to Push: Implementation of an Intravenous Iron Administration Quality Improvement and Waste Reduction Initiative in the Hemodialysis Unit

Healthcare contributes to environmental harm, with Hemodialysis (HD) among the most resource-intensive treatments. Intravenous (IV) iron sucrose is routinely administered by infusion in HD units despite product monographs permitting direct ("push") administration. IV infusion generates avoidable plastic waste. We conducted a quality improvement initiative across a regional kidney program in Canada to switch IV iron sucrose to push administration. A literature-informed safety and workflow review, supplemented by peer experience and prospective time trial on nursing time guided implementation. Safety events, nursing feedback, and consumable waste were evaluated. The pilot period prevented 36 kg of consumable waste, with estimated annual reduction of 1,548 kg. Consumable supply costs decreased by 75% following program-wide implementation. Transitioning iron sucrose from IV infusion to IV push is safe, feasible, and well accepted in HD settings, while substantially reducing waste and costs. This initiative demonstrates how evidence-based changes to practices can support environmentally sustainable kidney care.