Low-molecular-weight heparin (LMWH) use in an oncological setting

Emma Lowe, Melanie Lowe, Hilary Oldham, Joan Karasu.Clinical service technicians, Pharmacy Department, Christie NHS Foundation Trust

Introduction

Method Over a period of 5 weeks, we reviewed 26 in-patients on the Medical Assessment ward. We recorded, where possible, indication (DVT, PE, solid tumour), duration and confirmed the dose was appropriate for the patients current weight (according to the BNF) and the pharmacist/prescriber informed of any discrepancies.

Venous thromboembolism (VTE) occurs commonly in patients with cancer, other risk factors include; long-term immobilisation, surgery, and chemotherapy1. Therefore a high volume of oncology patients will be prescribed either a prophylactic, or treatment dose, of a LMWH.

Results/Discussion When the results of our review were collated, we found in 38% of patients, the prescribed dose was inappropriate for the patient. Out of these 38% of patients, 50% of patients had lost/gainedweight, 40% needed their dose reviewing as >1 month treatment and the remaining 10% had been prescribed a prophylactic dose instead of a treatment dose.

With regards to the NPSA Rapid Response Report NPSA/2010/RRR0144 this audit has highlighted the need for improvement and intervention within the Trust. The recommendations from the report need to be implemented, therefore as a team we aim to ensure that (where possible) patient weight, indication and date treatment commenced, are documented on the patient medication chart. We will also produce a quick reference guide (as per BNF information) for use on the ward, then re-audit in 12 months to compare results.

Conclusion

References1. Prevention of Venous Thromboembolism in Patients With Cancer. CancerThrombosis.org(online). Thrombosis

Research Institute, London. <http://www.cancerthrombosis.org/moduleArticle?id=4#ref22#ref22>[Accessed on 27/05/14]

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3. Cancer Information. Living With and After Cancer, Macmillan Cancer Support. <http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Livingwithandaftercancer.aspx> [Accessed on 28/05/14]

4. Rapid Response Report. Reducing treatment dose errors with low molecular weight heparins. NPSA, 2010. <http://www.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=75208&q=0%c2%acheparin%c2%ac > [Accessed on 28/05/14]

5. Fragmin (Dalteparin). Summary of Product Characteristics. eMC <http://www.medicines.org.uk/emc/medicine/26896/SPC/Fragmin+5000+IU/> [Accessed on 28/05/14]

6. NHS National Reporting and Learning Service (NRLS). Accurate Patient Weight (Signal) NPSA, 2010. <http://www.nrls.npsa.nhs.uk/resources/clinical-specialty/cancer-oncology/> [Accessed on 28/05/14]Date of preparation:

23/09/13

LMWH are prescribed based on a patient’s weight2 and oncology patients are more susceptible to weight fluctuations due to disease and/or treatment3. For example; inactivity, increased/reduced appetite, emesis or diarrhoea. It is important to ensure that patients are prescribed the correct dose of their LMWH as inaccurate prescribing can lead to an increased risk of haemorrhage, or increased risk of VTE. The purpose of this audit is to improve patient outcome by ensuring that they are prescribed the appropriate dose for their weight.