8th Annual WML Academic Symposium

Presenter(s): Jenny Rollins
Title: Evaluation of direct oral anticoagulants dosing schemes at a small community teaching hospital
Developed under the guidance of Dr. Kim Kelly , Pharmacy Practice

A medication use evaluation of patients admitted to either Betsy Johnson Hospital or Central Harnett Hospital over a six month period examined whether pharmacists and physicians appropriately dosed direct oral anticoagulants based on indication and dose adjustment information, per the package insert. Of the 227 orders reviewed, 48 orders (21.1 percent) were dosed inconsistently with the respective package insert. Pharmacists intervened 47.4 percent and 37.9 percent, respectively, on home medications and physician ordered medications. This study highlighted the importance of reviewing of a patient’s medical record to determine the indication for anticoagulation prior to dose adjustment for pharmacists and physicians.