Assignment On RXMAN Hospital.

RXMAN Hospital
Drug Use Evaluation Drug Use Evaluation of Enoxaparin at Sports
and Orthopedic Hospital
Background
Venous thromboembolism (VTE) is a condition whereby a clot forms in the
deep veins such as leg veins or arm veins (Heit, Spencer, & White, 2016). It
can eventually travel to the lungs or any other organ in the body especially
the heart. Most common trigger of VTE is surgery. Immobilization and
hospitalization are other triggers. All patients admitted are assessed for risk
of VTE using the Padua prediction score for risk of VTE. If the score is less
than 4 then the patient is a low risk while greater than 4 shows high risk and
enoxaparin prophylaxis is recommended so long as the patient does not
have any contraindication when performing lower limb surgeries of ACLR,
knee arthroscopy, and foot and ankle surgeries. The incidence of ACL
reconstruction rose to 74.6% in 2014 in the USA (Herzog et al. 2017). A study
that was done in Elite Collegiate Athletes reports a 27% prevalence rate of
knee and ankles surgeries.
Objectives
Evaluation of appropriateness of the use of enoxaparin, safety, and
compliance with current guideline for post-operative patients for the period
from January 2019 to June 2019
Methods
A retrospective chart prescription review conducted to include all post-
operative patients who were prescribed and discharged on enoxaparin
between January 1, 2019 and June 30, 2018. Clinical pharmacy team agreed
on the data criteria. Data was collected using an excel data collection form.
All collected data was analyzed.
Inclusion Criteria
All post-op patients who received and was discharged on enoxaparin
Exclusion Criteria
All outpatient (OPD) enoxaparin prescriptions
Definitions
Drug use evaluation (DUE)—an ongoing, systematic, criteria-based program
of medicine
evaluations that will help ensure appropriate medicine use. If therapy is
determined to be
inappropriate, interventions with providers or patients will be necessary to
optimize

pharmaceutical therapy.
Data Collection
From January 1, 2019 to June 30, 2019 there were 570 surgical procedures at
our hospital. During the same period there were 198 prescribed enoxaparin.
One of these prescriptions was an OPD prescription and was excluded
because the patient chose conventional treatment over surgery. From the
570 surgical procedures, 197 (35%) of the patients received enoxaparin
post op.
The hospital’s guideline:
As per the hospital’s procedure for individual risk assessment and
prophylaxis recommendations (E.2):
a. At Pre assessment Clinic, The Medical Consultant will assess and
document on the “Venous Thromboembolism Risk Factor
Assessment and Prophylaxis Recommendations” form, which
includes the following:
i. The individuals VTE risk
ii. Any risk factors associated with increased risk of bleeding and
contraindications to pharmacological prophylaxis
iii. Any contraindications to mechanical prophylaxis
b. Balancing the risks of VTE and bleeding and appropriate VTE
prophylaxis recommended. VTE prophylaxis will not be offered if the
patient has any risk for bleeding and the risk of bleeding outweighs
the risk of VTE.
c. At conclusion of surgery, the operating surgeon will review the
recommendations of the Medical Consultant on the “Venous
Thromboembolism Risk Factor Assessment and Prophylaxis
Recommendations” form, and document the final recommendations
(based on preoperative recommendations and knowledge of
duration of surgery, complexity of surgery and anticipated period of
immobility) regarding pharmacological prophylaxis which includes:
i. Whether LMWH is to be commenced post operatively or not, and
if so:
1) Commencement time of LMWH (e.g.: 6, 12, 24 hours post op)
2) Duration of LMWH
ii. Whether concurrent use of NSAIDs for post-operative analgesia is
permitted
d. Upon patient return to the ward, the Medical Consultant will review
the surgeon’s final recommendations and prescribe
pharmacological prophylaxis accordingly.

Results
Patient Demographics
 Patient Categories
5%5%
28%
11%19%
33%
Total
International
Athlete
Legend Athlete
Others Physically Active
Recreational
Athlete
Registered
Athlete
International Athlete
Legend Athlete
Others
Physically Active
Recreational Athlete
Registered Athlete
0 10 20 30 40 50 60 70
9
9
55
22
38
65
Count of Patient Category

 Age: 84% of Patients were age ≤ 40
≤ 40 > 40
165
32
Age
 Gender: male 142 (72%) and female 55 (28%)
28%
72%
Count of Male/Female
F
M
 Weight: Average 77.93687 (45, 121)
84%
16%
Chart Title
≤ 40
> 40