NUR 03.6 - Low Molecular Weight Heparin supply disruption – A model for safe switching

Background: For more than a decade tinzaparin was the preferred LMWH in the hospital (a tertiary referral centre and University teaching hospital), but the manufacturer recently informed Pharmacy of a disruption in supply. As tinzaparin shortage poses a significant threat to patients, a multidisciplinary team (MDT) was established, composed of experts in anticoagulation, nephrology and pharmacy.

Aims: To select an evidence-based alternative to tinzaparin and to develop hospital guidelines to safely prescribe the alternative LMWH. To evaluate the level of compliance with the LMWH guidelines and to ensure a safe and efficient switch. A review of LMWH incidents submitted to the risk department will be also conducted.

Methods: A review of alternative LMWHs, which hold marketing authorization in this country, was carried out. Drug charts of newly admitted patients were reviewed to ascertain compliance with the updated hospital guidelines on LMWH. Data collection was carried out in June 2022. The severity rating of LMWH incidents submitted to the Risk Department was analysed.

Results: Enoxaparin was the LMWH selected as the alternative to tinzaparin. Guidelines for prescribing, administration and monitoring were developed.
Drug charts were reviewed with 54% (62/114) having LMWH prescribed, of which 84% (52/62) had enoxaparin prescribed instead of tinzaparin, in compliance with the updated guidelines. Enoxaparin was prescribed in 47 patients for thromboprophylaxis, and in 5 for treatment.
Between 20th June and 14th August 2022, 16 medication incidents involving enoxaparin were submitted to the Risk Department, all of which had a severity rating classified as negligible.

Conclusion(s): LMWH shortages can pose a serious threat to patient safety. An MDT approach has shown how a safe and efficient switch from tinzaparin to enoxaparin was achieved in the hospital and this process could be used as a model for other hospitals to ensure treatment continuity and patient safety.