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[Preventive treatment of thrombosis: audit on heparin prescription]
P Aouizerate1, H Mabiala, F Perrot
1Service de Pharmacie, CHG de Meaux, France.
Insights
An audit of heparin use in a French hospital found that national guidelines improved prescription accuracy. Post-guideline implementation, 81% of preventive heparin doses correctly matched patient thrombotic risk.
Area of Science:
- Pharmacology
- Clinical Audit
- Evidence-Based Medicine
Context:
- Preventive heparin therapy is crucial for reducing thrombotic events.
- National guidelines for heparin use were disseminated in a French general hospital.
- Initial audits revealed significant discrepancies in heparin dosing and platelet monitoring.
Purpose:
- To evaluate the concordance between prescribed preventive heparin doses and patient thrombotic risk.
- To assess the adherence to platelet monitoring protocols.
- To determine the impact of national guidelines on heparin prescription practices.
Summary:
- An initial audit of 113 patients receiving preventive heparin (98% low molecular-weight heparin) showed only 52.2% received correct regimens, with significant overprescription (43.4%).
- Platelet monitoring was insufficient in 41% and not performed in 15% of cases.
- A follow-up audit one year after guideline dissemination demonstrated improved accuracy, with 81% of doses correctly adapted to thrombotic risk.
Impact:
- Implementing a feedback process based on clinical audits significantly enhances the appropriate use of preventive heparin.
- The study highlights the effectiveness of national guidelines and audit feedback in optimizing pharmacotherapy.
- This audit process should be considered for generalization to other critical therapeutic classes.
Abstract:
An audit has been carried out, in a French general hospital, studying the use of heparins in preventive indications, to assess concordance between prescriptions and thrombotic risk, before and one year after the diffusion of national guidelines. Platelet monitoring frequency has also been studied. On a defined day, 550 patients were admitted, and 113 treated with preventive heparinotherapy (low molecular-weight heparin: 98 per cent). 52.2 per cent of patients received a correct regimen, while 4.4 per cent of underprescriptions and 43.4 per cent of overprescriptions were observed. Platelet monitoring protocol was respected in 44 per cent of cases, while it was insufficient for 41 per cent and not carried out in 15 per cent. The results of this study have been communicated to all the prescriptors. Another audit done one year later showed that 81 per cent of doses were adapted to the thrombotic risk, 2 per cent were too low, and 17 per cent too high. The efficiency of this kind of process shows that it should be generalized to all the sensitive therapeutic classes.