Robert Tyler and Laura Sayers
Paisley’s Trauma and Orthopaedics Department prescribes enoxaparin for prophylaxis of thromboembolic events in both elective and trauma patients. It is pertinent that this is prescribed at the correct dose, adjusted for weight and renal function to ensure that prophylaxis is sufficient without increasing post-operative haemorrhage risk. Patients with a weight of less than 50 kgs or a creatinine clearance of less than 30 mls/minute should be prescribed a half dose of enoxaparin. Methods: Two periods of evaluation were undertaken involving a retrospective review of trauma and elective patients. The first loop examined 100 sets of case notes; the second loop examined 50 completing a full audit cycle. The following was extracted for each patient: 1) Admission dose of enoxaparin 2) Weight on admission 3) Creatinine clearance on admission For each patient, it was concluded whether that dose was appropriate for the patient using the weight and creatinine clearance. Results cycle one • 11% of prescriptions incorrect • 7% creatinine clearance incorrectly calculated • 4% weight <50 kg Intervention: 1) Designed original posters highlighting the need for dose adjustment in patients with low weight/impaired renal function 2) Displayed posters in clinical areas 3) Incorporated poster into new staff induction packs 4) Awareness amongst current staff rose through discussion and presentation of audit findings Cycle Two • 4% of prescriptions incorrect • Overall reduction in prescribing errors by of 63% Discussion: The two cycles showed that prescribing error. Is a significant problem and that patient safety was a concern, particularly on surgical wards where haemorrhage risk is increased. Successful changes were introduced which resulted in a noticeable improvement in prescribing practice.
