236 Assessing communication of duration of Dual Antiplatelet Therapy on discharge letters: an acute stroke unit audit

Abstract

Abstract Background Short term Dual Anti-Platelet Therapy (DAPT) is commonly used for secondary prevention of major acute ischemic stroke events. However, long-term DAPT is associated with increased risk of bleeding without reduction in cardiovascular events. Proton pump inhibitors (PPI) are often co-prescribed for prevention of gastroduodenal toxicity of DAPT, but long-term use has potential side effects. This audit aims to assess if clear instructions are provided regarding to duration of DAPT prescription in stroke medicine unit in tertiary referral hospital. Methods Retrospective analysis Electronic Medical Records (EMRs; discharge and clinical letters) who were admitted with TIA or AIS in 3-month period, excluding those who were transferred back to their referring hospital. Results 100 patients’ EMRs were reviewed. 34 were discharged on DAPT. 21 patients were reviewed in stroke OPD while 6 were readmitted to hospital. DAPT duration was documented in Discharge Letters (DL) of 28 patients (82%). In 28 (82%) patients, recommended durations of DAPT were documented in DL, 5(18%) of those were still inappropriately on DAPT on returning to OPD/readmission. 1 out of the 6 patients with no clear documentation of DAPT duration on DL were still inappropriately on DAPT. 22 patients were co-prescribed PPI, 19 of those had no documented recommended plan for PPI post completion of DAPT, and 12 of those were still on PPI on returning to OPD/readmission. 3 patients had a documented plan for PPI post completion of DAPT, 2 were still on PPI on returning to OPD/readmission. Conclusion Results were presented in stroke unit teaching. Key recommendations included education of NCHDs regarding clear documentation and communication with patients, pharmacists and GPs. Improvement in EMRs to highlight DAPT plan. Regular audits in this area.