LMC institutes new pharmacy-driven protocol to adjust enoxaparin

 

Submitted by Robert Benz, Vice President of Medical Affairs, Lankenau Medical Center

 

Effective September 20, 2016, Lankenau Medical Center instituted a new pharmacy-driven protocol to adjust enoxaparin (prophylaxis doses only) based on creatinine clearance and/or weight/BMI.  Previously, the pharmacists evaluated each enoxaparin prophylaxis order and text/page prescribers for dose adjustments and then wait for either a call-back or an order change.   Ideally this new program will cut down on these text/pages, improve the turnaround time/delayed doses while pharmacists are waiting for clarification/call back  and improve the appropriate dosing of enoxaparin for VTE prophylaxis.

 

Pharmacist will only be adjusting those enoxaparin prophylaxis orders initiated by a prescriber, based on the following (taken from the VTE order set):

 

Enoxaparin 40mg subQ every 24 hrs · BMI less than 40 and CrCl is greater than 30mL/min OR

· BMI greater than or equal to 40 and CrCl is between 15 to 30 mL/min

Enoxaparin 30mg subQ every 24 hrs · BMI less than 40 and CrCl is between 15 to 30mL/min OR

· Actual weight is less than 45kg and CrCl is greater than 15 mL/min.

Enoxaparin 40mg subQ every 12 hrs · BMI greater than or equal to 40 and CrCl is greater than 30mL/min

 

Patients excluded from this pilot will include:  (1) Those less than 18 years of age; (2) All CT surgery and trauma patients; and (3) Those in which the prescriber specifies “Do Not Adjust” for their enoxaparin prophylaxis orders.

 

Pharmacy will monitor all enoxaparin prophylaxis patients and adjust doses during the patient’s hospitalization based on increases or decreases in renal function.  If the renal function deteriorates to less than 15ml/min, the pharmacist will contact the prescriber to discuss changing enoxaparin to heparin if the prescriber wants to continue pharmacological prophylaxis.

 

I have attached the pharmacy protocol for additional information.  If you have any questions, please contact me.  Thank you.

 

 

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