Education together with a preprinted sticker improves the prescribing of prophylactic enoxaparin

Substantial evidence exists for the use of prophylactic heparin in medical inpatients with congestive heart failure and severe respiratory disease, and in surgical patients with a moderate-to-high risk of thromboembolism (Grade 1A recommendations). Despite this, many patients who would benefit from prophylaxis do not receive this treatment.

We implemented an education programme to promote the use of prophylactic enoxaparin. In addition, preprinted stickers were placed in the notes of patients to serve as a reminder, where appropriate, that the patient was a candidate for prophylaxis. To assess changes in practice, we undertook an audit of the charts of 105 medical patients and 100 surgical patients over a 3-month period before the intervention and a further 100 medical patients and 99 surgical patients over a 3-month period after the intervention.

Before the campaign, prophylaxis with enoxaparin was used in 11% of eligible medical patients. Following the intervention, prophylaxis increased to 47% (95%CI 23-50, p<0.0001). The audit of surgical patients showed an increase in the use of enoxaparin from 36% of eligible patients to 50% (95%CI 0-28, p = 0.07) however there was no improvement in the proportion of those treated who received the appropriate dose according to guidelines.

Prophylactic heparin is under-used. An education programme together with the use of a sticker led to an improvement in the use of this treatment.