Kendall Mores, PharmD
PGY2 Critical Care Pharmacy Resident
n/a
Chicago
Disclosure information not submitted.
Lara Ellinger, PharmD, BCPS
Medication Safety and Drug Information Pharmacist
Northwestern Memorial Hospital, United States
Disclosure information not submitted.
Title: Anticoagulant Dose Stacking-Related Bleeding Events with a Widened Medication Administration Window
Introduction/Hypothesis:
During the COVID-19 pandemic, the medication administration window at Northwestern Memorial Hospital (NMH) was widened from 2 hours to 4 hours to bundle care and decrease nursing staff exposure to COVID-19 and use of personal protective equipment. The purpose of this research is to assess if widening the window affected patient safety, specifically anticoagulant-related bleeding events.
Methods:
This was a single-center, retrospective quality assurance study. Dose stacking events of scheduled anticoagulants in the inpatient setting were included. A dose stacking event was defined as administration of once daily doses ≤8 hours apart, twice daily doses ≤6 hours apart, three times daily doses ≤3 hours apart, and four times daily doses ≤2 hours apart. The primary outcome was frequency of bleeding events associated with dose-stacked anticoagulant medications 6 months before and after 4/15/2020, the date the medication administration window was widened. Secondary outcomes were major bleeding and minor bleeding.
Results:
A total of 208 dose stacking events occurred during the study period, with 91 before and 117 after the window was widened. There was one bleeding event before the window was widened and six bleeding events after the window was widened (1.1% vs. 5.1%, P = 0.139). The implicated anticoagulants included apixaban (3, 42.9%) and subcutaneous heparin (4, 57.1%). Five (71.4%) of the bleeding events were gastrointestinal bleeding, one (14.3%) was a hematoma at a subcutaneous heparin injection site, and one (14.3%) was hematuria. Three (42.9%) bleeding events were classified as major bleeding and four (57%) were classified as minor bleeding. There was no difference in major (1.1% vs. 1.7%, P = 1.00) or minor (0 vs. 3.4%, P = 0.258) bleeding events before or after the medication administration window was widened.
Conclusions:
Overall, widening the medication administration window at NMH was not associated with an increase in all anticoagulant-related bleeding events. This information contributes to understanding the safety implications of widening the nursing medication administration window for scheduled medications.