Evaluation of the Implementation of an Anticoagulation Management Protocol at a Community Hospital

Purpose: The objective of this study was to evaluate the impact of implementation of an anticoagulation protocol involving dosing and monitoring of unfractionated heparin (UFH) and low-molecular-weight heparin, specifically enoxaparin, for the treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and/or acute coronary syndromes (ACS). Methods: Patients with a primary diagnosis of DVT, PE, and/or ACS treated with UFH and/or enoxaparin were included. Data were collected on patients admitted to a community hospital during February 2008 (preimplementation) and February 2009 (postimplementation). Results: Forty-six patients were included in the preimplementation group and 25 patients in the postimplementation group. Forty-six percent of patients were dosed properly in the preimplementation group (UFH 38% and enoxaparin 50%) compared to 76% in the postimplementation group (UFH 56% and enoxaparin 88%; P = .023). Fifty-four percent of patients were monitored properly in the preimplementation group (UFH 31% and enoxaparin 67%) compared to 68% in the postimplementation group (UFH 56% and enoxaparin 75%; P = .318). Conclusion: Standardized dosing with a multidisciplinary-managed anticoagulation protocol significantly increased proper dosing of anticoagulation therapy; however, the protocol did not significantly improve proper monitoring. A lack of understanding of the need for baseline laboratory data contributes to improper monitoring. An approach which includes significant educational strategies is necessary to optimize patient care.