Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients

• Published in: American journal of health-system pharmacy Vol. 75; no. 6; pp. 392 - 397
• Main Authors: Popoola, Victor O, Lau, Brandyn D, Tan, Esther, Shaffer, Dauryne L, Kraus, Peggy S, Farrow, Norma E, Hobson, Deborah B, Aboagye, Jonathan K, Streiff, Michael B, Haut, Elliott R
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 15-03-2018; American Society of Health-System Pharmacists
• Subjects: Analgesics; Anticoagulants; Anticoagulants - administration & dosage; Antihypertensives; Antiretroviral agents; Antiretroviral drugs; Antiviral agents; Central nervous system agents; Cohort Studies; Comparative analysis; Drug therapy; Drugs; Electrolytes; Electronic records; Epilepsy; Gastrointestinal agents; Health care facilities; Hospital patients; Hospitalization; Humans; Injections, Subcutaneous; Medical centers; Medical records; Medical research; Medication Adherence - statistics & numerical data; Patient compliance; Prophylaxis; Psychotropic drugs; Retrospective Studies; Thromboembolism; Treatment Refusal - statistics & numerical data; Venous Thromboembolism - prevention & control; Vitamins; anticoagulants; patient safety; electronic medical records; medication adherence; nonadministration
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp161057

PURPOSE.Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented.
METHODS.The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated.
RESULTS.Overall, 12.7% of all medication doses prescribed to patients in the study cohort (n = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], p < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, p < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications.
CONCLUSION.Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types.