Category: Federal Forum Posters
Purpose: Prescribing of direct oral anticoagulation (DOAC) therapy is complex as medication dosing recommendations vary between drugs and are dependent on several factors such as indication, age, and comorbidities. Anticoagulants pose an inherent risk for bleeding or clotting which may be potentiated by incorrect dosing. There have been anecdotal reports of inconsistent prescribing in the emergency department, however the extent has not been evaluated. The aim of this quality improvement project is to assess the appropriateness of initial DOAC prescribing within the emergency department.
Methods: This retrospective chart review will be performed using data obtained from the electronic medical record (EMR) for patients initiated on DOAC therapy in the emergency department between September 15, 2017 and September 15, 2018. The primary objective will be to evaluate the appropriateness of dosing with initial prescriptions for DOACs for atrial fibrillation or venous thromboembolism (VTE) from a VA emergency department compared to FDA approved dosing and evidence based guidelines. Secondary objectives include recognition of prescriptions written for patients with contraindications or precautions for use, and if the presence of a clinical pharmacy specialist in the emergency department resulted in an increased rate of appropriate prescribing. Data collected from the EMR to assess objectives will include the patient’s age, gender, height, weight, serum creatinine, indication for use, prescription for DOAC or enoxaparin, or both, doses, quantities prescribed, and time and date of prescriptions written. The data will be assessed for trends using descriptive statistics.
Results: not applicable
Conclusion: not applicable
Michael Bryant– PGY1 Pharmacy Resident, Orlando VA Medical Center, Oviedo, FL