Background Anticoagulants are high-risk drugs so they require regular analytical monitoring to ensure adequate levels of safety and efficacy.
Purpose To identify and quantify the prescription errors that occur during the hospital admission of patients taking anticoagulants with vitamin K antagonists (VKA) and enoxaparin. To quantify the degree of acceptance of the intervention of the pharmacist to avoid such errors.
Material and methods Prospective observational study conducted in a hospital. Duration: 5 months. Patients included those taking anticoagulants with VKA who were admitted to the hospital and underwent an analytical check by haematology on admission. Sources of information: Silicon v. 9.59 electronic prescription program and haematology instructions. Discrepancies between the prescription of the anticoagulant and the instructions were codified: VKA1 Different VKA dose prescribed. VKA2 Lack of enoxaparin prescription. VKA3 Different enoxaparin frequency. VKA4 Different enoxaparin dose. VKA5 Lack of VKA prescription. VKA6 VKA does not match instructions. VKA7 Instructions recommend discontinuing enoxaparin and on the prescription it is not discontinued. VKA8 Enoxaparin prescribed when it is not recommended in the instructions. VKA9 Apixaban, enoxaparin and acenocoumarol prescribed. Pharmaceutical interventions (PI): PI1 Suspend medication and prescribe the correct one. PI2 Suggest prescription of necessary medication. PI3 Correct enoxaparin frequency. PI4 Correct enoxaparin dose. PI5 Prescribe the VKA. PI6 Review instructions. PI7 Suspend enoxaparin (recommendation in instructions). PI8 Suspend enoxaparin (no recommendation in instructions). PI9 Interaction with other anticoagulants.
Results One hundred and nine patients were analysed (194 haematology instructions). Errors in the prescription: 37.63%. Degree of acceptance of PI: 100%. The discrepancies and interventions detected were: VKA5, I5 (37%), VKA2, I2 (20.55%), VKA1, I1 (12.35%), VKA and I4, six, seven and eight (6.85%) and VKA and I3, nine (1.35%).
Conclusion In our population, a high percentage of errors were detected in the prescription of anticoagulants. Pharmaceutical intervention was key to minimising prescription errors and improving patient safety.
References and/or Acknowledgements Acknowledgements to the Congress.
No conflict of interest
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