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An Audit of Prescribing LMWHs in Acute Coronary Syndrome
Katrina LinesMedical Student, Cardiff University
Dr Rob PerryClinical Supervisor, Consultant in Emergency Medicine
Background
Enoxaparin (Clexane®)
Current Guidelines
Weight1mg/kg BD5
Renal functionIf GFR <30ml/min, reducedose to 1mg/kg OD6
Weight Renal Function
Methodology
Results19 patients identified
Weight40% - Emergency Department47% - medical wards26% had no recorded weight
Renal FunctionNo patients had a documented eGFRInconsistent prescribing
Overall26% received the wrong dose
Interventions
Letter to Nurses in Charge
Change nursing documents
Poster campaign
Emergency Department
Biochemistry
Acute Medical Wards
Poster campaign
Prescribing guidelines poster
eGFR routine
Talk to ward pharmacist
Prescribing sticker
So did we improve things?
No.
Proportion of patients weighed Proportion of patients prescribed correct dose
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
74% 74%50%100% Pre-Intervention
Post-Intervention
Recommendations
More weighing facilities
Local policy on weighing patients
Local policy on prescribing in renal impairment
Multidisciplinary teaching
Lack of equipment
Confusion
Confusion & lack of awareness
Weight
Renal FunctionDosing chart/sticker
References1. Peters RJ, Mehta S, Yusuf S; Acute coronary syndromes without ST segment elevation. BMJ. 2007 Jun
16;334(7606):1265-9
2. LaPointe NM, Chen AY, Alexander KP, et al. Enoxaparin dosing and associated risk of in-hospital bleeding and death in patients with non-ST-segment elevation acute coronary syndromes. Archives of Internal Medicine. 2007; 167:1539-44
3. Hoffmann P. Keller F. 2012. Increased major bleeding risk in patients with kidney dysfunction receiving enoxaparin: a meta-analysis. Eur J Clin Pharmacol. 2012. 68(5):757-65
4. National Patient Safety Agency. Reducing treatment dose errors with low molecular weight heparins. July 2010. Available at: www. nrls.npsa.nhs.uk/resources (accessed 25th September 2012)
5. British National Formulary 63rd edition. London. British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012.
6. Clexane pre-filled syringes. Summary of Product Characteristics last updated on the eMC: 03/01/2012. Available at: http://www.medicines.org.uk/emc/ (accessed 26th September 2012)
7. McArtney R et al. An audit of therapeutic doses of low molecular weight heparins. Clinical Pharmacist. 2011; 3:158
8. Hilmer SN et al. Failure to weigh patients in hospital: a medication safety risk. Int Med J. 2007; 37:647-50
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