The impact of an electronic alert to reduce the risk of co-prescription of low molecular weight heparins and direct oral anticoagulants

Abstract

ObjectiveTo use the electronic prescribing system to identify how prescribers have responded to the duplicate ‘Anticoagulant Alert’ and the extent to which the system has prevented unintentional prescription of Low Molecular Weight Heparins (LMWHs) to patients prescribed Direct Acting Anticoagulants (DOACs). To determine the clinical appropriateness of the actions taken by the prescriber following the alert override and the impact this has on patient safety. Material and methodsA retrospective service evaluation was conducted to determine the impact of a duplicate ‘Anticoagulant Alert’ on the prevention of prescription of LMWHs to patients already prescribed DOACs at a 950-bed acute teaching hospital in the UK. The number of alert overrides, actions taken by the prescriber following the alert override, and the clinical appropriateness of prescribers’ actions over the 15-month period 26th June 2017 – 8th October 2018 were evaluated. ResultsOf the 894 alerts that triggered over the study period 111 were in response to attempts to prescribe a LMWH to a patient prescribed a DOAC. The alert was overridden in 65 (58.6%) cases but accepted, preventing co-prescription of duplicate anticoagulants, in 46 (41.4%) cases. Overrides were appropriate and justified in 44/65 cases. In 6 cases duplicate anticoagulants were prescribed and administered but without patient harm. ConclusionThe anticoagulant alert prevented duplicate anticoagulant prescribing for 46 patients reducing the risk of patient harm from duplicate-anticoagulation. The 58.6% of alerts that were overridden were appropriate and justified in the majority of cases. Where duplicate doses were administered, no harm was observed. The electronic alert has improved the safe use of anticoagulants within our organisation.