330 Evaluating anticoagulant prescribing errors in older adults in a rehabilitation setting

Abstract

Abstract Background Anticoagulant use is common in older adults for the prevention or treatment of a number of conditions, most commonly Venous Thrombo-Embolism (VTE) or to prevent stroke in atrial fibrillation. Our audit aimed to review anticoagulation prescribing practices, identify errors and areas for improvement. Methods The initial retrospective audit of all inpatients in a medical gerontology ward took place from 15/11/2022–30/12/22. Data collected included age, sex, weight, renal profile, anticoagulation type, dose and indication. Information was collected from medication records, clinical notes and online laboratory system. After initial audit, multiple education sessions were conducted with the medical team. Re-audit of all inpatients occurred from 05/04/2023–25/04/2023. The guidelines used were the HSE Prescribing Tips for Anticoagulation and local Hospital Guidelines on VTE prophylaxis. Results The initial audit of 73 patients showed 15% (11) rate of prescribing error with 7 subtherapeutic and 4 supratherapeutic doses. Of these 11 errors, 4 doses were corrected recently prior to audit. Average age was 82.6 (64–100) and 55% (40) were female. The re-audit of 51 patients showed the rate of error improved to 7.84%(4) with 4 supratherapeutic doses. 1 dose was corrected on admission and 5.88%(3) required dose adjustment due to fluctuations in weight and renal function throughout admission. Average age was 83.1(66–103) and 69%(35) were female. Conclusion The re-audit demonstrated ongoing education sessions reduces prescribing error with a 48% reduction. However ongoing monitoring throughout admission is required to account for fluctuations in weight and renal function. Suggestions for further improvements include ongoing regular education sessions with the medical team. Further sessions are planned with the wider multidisciplinary team members to highlight importance of regularly monitoring weight and renal function and medication dosages. This audit also reinforces the importance of the role of pharmacist in the multidisciplinary team in Rehabilitation Units and would support regular pharmacist input on an regular basis.