PB1474 - Analysis of Thromboprophylaxis Prescribing Using a Cohort Extraction and Information Retrieval Platform, a UK Experience

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

JB

Jessica L. Buckley, MPharm, MRPharmS

Senior Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Co-Author(s)

GK

Gulden Kurtoglu

MPharm Student
Institute of pharmaceutical science; King’s College London
London, England, United Kingdom
HN

Himani Narendra

MPharm Student
Institute of pharmaceutical science; King’s College London
London, England, United Kingdom
MA

Mohammad Al-Agil

Data Analyst
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Presenting Author(s)

Rachel E. Clapham, MPharm

Anticoagulation Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Co-Author(s)

BP

Beth Paey

Teaching Fellow
Institute of pharmaceutical science; King’s College London
London, England, United Kingdom
Rosalind A. Byrne

Principal Pharmacist Anticoagulation
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
JP

Jignesh P. Patel

Reader and Honorary Consultant Pharmacist in Anticoagulation
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Roopen Arya, MA PhD FRCP FRCPath

Professor of Thrombosis and Haemostasis
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Lara N. Roberts, MD (she/her/hers)

Haematology Consultant
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Victoria Speed, PhD

Specialist Anticoagulation Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalised patients. Recently, over half of litigation cases for hospital associated VTE were linked with no VTE risk assessment or prescribing of thromboprophylaxis in England. Audits of VTE prevention practice by large institutions are often limited to time consuming manual data collection.

Aims: To explore the feasibility of using an information extraction application framework (CogStack) to report appropriateness of thromboprophylaxis prescribing at King's College Hospital.

Methods: Adult patients admitted to medical and surgical wards in July 2022 with a first dose of enoxaparin thromboprophylaxis were identified across two hospital sites. For each patient, the dose of enoxaparin was extracted, as well as the weight and eGFR, contemporaneous with that admission. Dose appropriateness was based on local guidelines. A case note review was conducted to extract the VTE risk assessment and the number of non-recommended doses administered. Analyses were up to four days into hospital admission.

Results: 1805/1846 (98%) had a VTE risk assessment completed. In total, 1349/1805 (75%) were assessed as ‘high risk of VTE, low risk of bleeding’. Weight and eGFR were recorded for 1246/1349 (92%) patients and 1067/1246 (86%) prescriptions were appropriate. The proportion of appropriate prescriptions according to weight and eGFR are presented in Tables 1 and 2. In patients weighing < 50kg with an inappropriate dose, 40/41 (98%) were prescribed higher than the recommended dose. In patients weighing 101-150kg with an inappropriate dose, 45/53 (85%) were prescribed less than the recommended dose. 89/179 (50%) received more than one non-recommended dose.

Conclusion(s): The CogStack framework enabled systematic extraction of thromboprophylaxis prescriptions linked to weight and renal function. This method of reproducible information retrieval could provide a near real-time view of thromboprophylaxis prescribing across a large trust, informing timely clinical intervention and targeted education.