Presentation Details
| The impact of a high-risk anticoagulation prescribing stewardship scoring tool implementation in an inpatient setting Emma Baker1, John Lindsley1, Ian Watt1, Rakhi Naik2, Michael Streiff2, Jennifer Yui2, Kathryn Dane1. 1The Johns Hopkins Hospital Department of Pharmacy, Baltimore, MD, USA.2Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA |
Abstract
Background: A Hemostatic and Antithrombotic Stewardship Program was created at The Johns Hopkins Hospital in August of 2017. As part of stewardship program implementation, an electronic medical record (EMR) based scoring tool was developed to identify patients with high-risk combinations of individual patient characteristics and active anticoagulant orders which impact the safety or efficacy of anticoagulant therapy. The scoring tool evaluates a combination of patient demographics, medical history, and active medication orders to generate a score which flags high-risk patients for review by antithrombotic stewardship pharmacists. Through these reviews, the stewardship pharmacists identify opportunities for optimization of therapy. Patient reviews and recommendations are documented and stored in the EMR. This project will evaluate the clinical impact of this initiative, identify educational opportunities, and illustrate areas for improvement in the build specifications of the scoring tool. Objectives: The objective of this study was to evaluate the impact of implementation of an EMR-based high-risk anticoagulation prescribing stewardship scoring tool at a large academic medical center. Methods: A single-center, retrospective, observational cohort study was conducted from January 26, 2022, to September 23, 2022. Admitted adult patients with documented antithrombotic stewardship scoring tool reviews by stewardship pharmacists or trainees during the study period were included. Patients with missing data were excluded. The details of eligible high-risk anticoagulation scoring tool reviews were collected, including the medication and high-risk criteria involved, recommended therapy changes, and recommendation acceptance. The endpoints for this study were to quantify and categorize recommendations made through use of the scoring tool, evaluate the rate of accepted recommendations, and characterize scoring tool reviews which did not result in a recommended change in therapy. Results: A total of 643 patients were reviewed by stewardship pharmacists and trainees during the study period and included in the final analysis predominantly from medicine or surgical services (Table 1). The scoring tool identified 824 medication and high-risk patient characteristics (triggers) which generated a score for review (Table 2). Overall, direct oral anticoagulants (DOACs) made up the majority of reviews (n=419, 65%). The most common high-risk characteristics prompting review were obesity (n=151, 18.3%), apixaban 2.5 mg BID orders (n=138, 16.7%), and low body weight (n=120, 14.6%). Scoring tool use resulted in 125 recommendations (19%), with 91 recommendations implemented (73%). The most common recommended change in therapy was apixaban dose adjustment (n=27, 22%). Conclusions: Utilization of a high-risk anticoagulation prescribing stewardship scoring tool by anticoagulation stewardship pharmacists resulted in improvements in anticoagulation management at a large academic medical center. The use of stewardship scoring tools can help focus efforts of stewardship team members to more efficiently to review high-risk anticoagulant prescribing. Future directions will include refining scoring tool workflows to improve efficiency and provider education for commonly encountered high-risk prescribing practices.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.