Impact of provider-specified order indication on appropriateness of direct oral anticoagulant dosing Jennifer Rollins, Ruthanne Baird, Neil Wheeless, Jason Moss, Kim Kelly Campbell University College of Pharmacy & Health Sciences - Buies Creek, NC
Background/Purpose: The use of direct oral anticoagulants (DOACs) has increased as studies have shown that they are superior or noninferior to warfarin. This, along with decreased monitoring in comparison to warfarin, has increased their use in patients requiring anticoagulation. Given the varying dosing schemes for labeled indications among DOACs, the indication for anticoagulation is not always clear to pharmacists in medical records. Previous studies have shown that DOACs are often dose-reduced despite package insert recommendations. A provider-specified order indication was added to order entry to clarify the indication for anticoagulation when a patient_x0019_s medical history is unclear in documentation. The provider-specified order indication requires that providers type an indication for anticoagulation whenever an anticoagulant is ordered. The indication is required regardless of whether the anticoagulant is a home medication being continued during an inpatient stay or newly prescribed during the hospitalization. This retrospective review will evaluate whether pharmacist intervention and indication-concordant prescribing of DOAC dosing improved when indication is specified at order entry.
Methodology: The primary objective of this study is to compare the rate of indication-concordant prescribing of DOAC dosing before and after provision of a provider-specified order indication. All patients receiving DOACs over a six-month period will be identified and evaluated for appropriateness of drug therapy and pharmacist intervention based on institution approved practices or recommendation to prescriber. This group will be compared to a retrospective control group prior to the implementation of a provider-specified order indication. Expected results will determine whether the implementation of a provider-specified order indication improved the accuracy of DOACs for respective indication.
Presentation Objective: Evaluate whether an indication specified at order entry improved the accuracy of DOAC prescribing and pharmacist intervention.
Self-Assessment: Does specifying indication for anticoagulation improve the accuracy of DOAC dosing and assist in pharmacist intervention?
