PMID- 20569760
OWN - NLM
STAT- MEDLINE
DCOM- 20100715
LR  - 20220321
IS  - 1555-7162 (Electronic)
IS  - 0002-9343 (Linking)
VI  - 123
IP  - 6
DP  - 2010 Jun
TI  - Adherence to pharmacological thromboprophylaxis orders in hospitalized patients.
PG  - 536-41
LID - 10.1016/j.amjmed.2009.11.017 [doi]
AB  - OBJECTIVE: We compared adherence to unfractionated heparin (UFH) 2 or 3 times 
      daily prophylaxis orders versus low-molecular-weight heparin (LMWH) once daily 
      orders. Our goals were to determine which strategy demonstrated the best 
      adherence in terms of timing and frequency of dose administration, and to 
      determine reasons for ordered heparin not being administered. METHODS: We queried 
      our electronic medication administration record where nurses document reasons for 
      delayed administration or omitted doses. We identified 250 consecutive patients 
      who were prescribed prophylaxis with UFH 2 or 3 times daily or LMWH once daily. 
      We followed patients for their hospitalization to determine adherence to 
      physicians' prophylaxis orders. RESULTS: Adherence, defined as the ratio of 
      prophylaxis doses given to doses ordered, was greater with LMWH (94.9%) than UFH 
      3 times daily (87.8%) or UFH twice daily (86.8%) regimens (P <.001). Patients 
      receiving LMWH more often received all of their scheduled prophylaxis doses (77%) 
      versus UFH 3 times daily (54%) or UFH twice daily (45%) (P <.001). There were no 
      differences between regimens regarding reasons for omitted doses. The most common 
      reason for late or omitted doses was patient refusal, which explained 44% of the 
      UFH and 39% of the LMWH orders that were not administered. CONCLUSIONS: LMWH once 
      a day had better adherence than UFH 2 or 3 times daily. For both LMWH and UFH, 
      patient refusal was the most common reason for not administering prophylaxis as 
      prescribed. These findings require consideration when evaluating pharmacological 
      prophylaxis strategies. Educational programs, explaining the rationale, may 
      motivate patients to improve adherence during hospitalization.
CI  - Copyright 2010 Elsevier Inc. All rights reserved.
FAU - Fanikos, John
AU  - Fanikos J
AD  - Department of Pharmacy, Brigham and Women's Hospital, Boston, MA 02115, USA.
FAU - Stevens, Leslie Ann
AU  - Stevens LA
FAU - Labreche, Matthew
AU  - Labreche M
FAU - Piazza, Gregory
AU  - Piazza G
FAU - Catapane, Elaine
AU  - Catapane E
FAU - Novack, Lena
AU  - Novack L
FAU - Goldhaber, Samuel Z
AU  - Goldhaber SZ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Adult
MH  - Advance Directive Adherence/*standards
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - *Inpatients
MH  - Male
MH  - *Medication Adherence
MH  - Middle Aged
MH  - *Patient Compliance
MH  - Thromboembolism/*prevention & control
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2010/06/24 06:00
MHDA- 2010/07/16 06:00
CRDT- 2010/06/24 06:00
PHST- 2009/09/01 00:00 [received]
PHST- 2009/11/19 00:00 [revised]
PHST- 2009/11/20 00:00 [accepted]
PHST- 2010/06/24 06:00 [entrez]
PHST- 2010/06/24 06:00 [pubmed]
PHST- 2010/07/16 06:00 [medline]
AID - S0002-9343(10)00066-5 [pii]
AID - 10.1016/j.amjmed.2009.11.017 [doi]
PST - ppublish
SO  - Am J Med. 2010 Jun;123(6):536-41. doi: 10.1016/j.amjmed.2009.11.017.